Healthcare Finance Staff

States, insurers and self-funded employers are facing mounting pressure to expand autism coverage, but some may be too slow for advocates.

The federal government and a number of hospitals may want to transition to a new Medicare reimbursement model. But there are still billions of dollars in disputed fee-for-service claims waiting to be settled.

Sweeping changes in insurance regulation, increasingly constrained access, growing need for consumer-focused services, and escalating costs are redefining the payer business. Developing the right mix of front, middle, and back office capabilities has become critical post-reform and created an attractive area of potential investment for private equity.  

Amid the transition to the Affordable Care Act, startup companies looking to augment, service or replace health insurance have been getting record investments.

The federal government has granted itself potent new authority to expel physicians from Medicare if they are found to prescribe drugs in abusive ways, following through on a proposal issued earlier this year.

AmeriMark Direct started its mail order catalog business here in the 1960s, and for decades, everyone assumed that health insurance came with the job.

With millions of Americans on new exchange plans now responsible for high deductibles, hospitals, drug makers, insurers and regulators are entering a new frontier of payment disputes.

Healthcare payers have made great strides to improve claims errors and drive down costs. The AMA's 2013 National Health Insurer Report Card recently found a significant reduction in the claims error rate to an average of seven percent among the nation's largest commercial health insurers. But there is still work to do.

As more exchange enrollment data emerges, so too is a premium strategy that in the long-run may act as a market check of sorts.

Highmark is changing its CEO for the third time in as many years. An executive whose work spans jewelry, fabrics and eyeglasses is taking the helm of a new integrated payer-provider in the early stages of a market war.