Healthcare Finance Staff

Talks between West Penn Allegheny Health System and Highmark resumed Monday after a judge ruled last week that Highmark had not breached the $475 million merger deal, effectively barring West Penn from negotiating a new deal with other companies.

Now that the federal government is set to run Missouri's health insurance exchange, after voters passed a proposition banning state creation of an exchange without legislative or voter approval, lawmakers say they'd actually like to create their own.

North of the Mason-Dixon Line, it's hard to find a state that has given more of a cold shoulder to President Barack Obama's health law than Maine.

Brian Klepper comments on the American Academy of Family Physicians' recent moves to knock down the idea that nurse practitioners are equivalent to physicians for primary care. He mainly concedes their point -- after all family physicians have about quadruple the training of NPs -- but he's surprised that AAFP is training its sights on NPs rather than specialists.

Now that the election is over and the Affordable Care Act has been made permanent by the Supreme Court's decision, governors who have been sitting on healthcare decisions have "a lot of pent up energy" for moving forward, said former Republican Senate Majority Leader Bill Frist at a post-election healthcare meeting held in Washington, D.C., on Thursday.

With Medicare enrollment and spending set to grow in the coming decades, the program needs to better spread risk and incentivize value and also needs a better statutory definition of cost-benefit considerations, researchers argue in the latest issue of the New England Journal of Medicine.

Helping providers prepare for what some have called a coming reimbursement war, the tech firm SAI Global Compliance has unveiled an application called the "Claims Denial Manager," designed to limit losses from pre-payment claims denials. 

Following the devastation of post-tropical storm Sandy, the Centers for Medicare & Medicaid Services (CMS) issued blanket waivers of particular requirements that include all hospitals, skilled nursing facilities, home health agencies, hospice and end-stage renal disease facilities in the areas of New York and New Jersey that were strongly affected by the storm.

Proposals to allow for the sale of health insurance across state lines have long been touted as one way of effectively lowering the price of health insurance, particularly in states where there is a highly concentrated insurance market. The argument goes that resultant increased competition would encourage a state's existing health plans to lower prices in the face of the new market entrants.

Private health insurance exchanges are sprouting up and established ones want to grow, challenging state-based HIXs and expanding the retail insurance market. Insurers, in anticipation of the expected shifts in the marketplace, are positioning themselves in a big way to take advantage of this trend.