Healthcare Finance Staff

Commercial and government programs have witnessed a busy year -- most notably with the first year of commercial marketplace EDGE server data submission for risk adjustment; reinsurance coming to a close at the end of April; and the draft payment report being issued at the end of June.

While the Centers for Medicare and Medicaid Services announced a year's grace period this summer when it comes to claims coded with ICD-10, not all large commercial payers are following suit.

Due to concerns of insolvency, federal and state officials have ordered the nonprofit co-op Health Republic Insurance of New York to cease writing policies and to close by the end of the year.

President Barack Obama signed legislation last week that makes a significant change in the health law's small business rules, following a rare bipartisan effort to amend the health law.

A new report by the Health Research Institute of PricewaterhouseCoopers says the transformation from fee-for-service to value-based reimbursement will take longer than the ambitious timeline announced in January by Health and Human Services Secretary Sylvia Burwell.

Horizon Blue Cross Blue Shield of New Jersey's new ONMIA health alliance is under scrutiny from legislators in the state who want to delay the plan's rollout amid questions of how hospitals were chosen for the Tier 1 network.

While payer-provider collaboration has long been important, new trends in managing population health data is strengthening that relationship as never before, according to MedeAnalytics CEO Andy Hurd, and in many ways it's changing how providers think.

"Severe and unexpected cuts" to Medicaid payments in the Connecticut budget have stalled talks of a joint venture between Hartford HealthCare and Day Kimball Healthcare, according to Hartford HealthCare.

Out-of-network providers charged patients on average 300 percent more than the Medicare rate for certain treatments or procedures, according to the analysis of 2013 and 2014 claims data released Thursday by the America's Health Insurance Plans.

Chronically ill people enrolled in individual health plans sold on the Affordable Care Act insurance exchanges pay on average twice as much out-of-pocket for prescription drugs each year than people covered through their workplace, according to a study published Monday in the Health Affairs journal.