Healthcare Finance Staff

Federal regulators are starting to finalize simmering ideas for public exchanges and also responding to consumer concerns, outlining a new quality rating system and proposals covering everything from narrow networks to loss ratios.

The days of cryptic invoicing are coming to an end for healthcare, or at it least they should be, financial experts say.

The Medicaid and CHIP Payment and Access Commission is out with its biannual report, proposing a number of changes to eligibility, premiums and disclosure policies, including some intertwining with exchange health plans.

Several months of sustained legislative progress on physician payment reform has been stopped in its tracks by an add-on.

As Montana's Blue Cross company evolves under a new corporate parent, state regulators are penalizing it for some alleged past misdeeds uncovered by an audit.

Anthem Blue Cross and Blue Shield in Colorado has convinced one-third of the state's primary care providers to join its value-based payment program, part of a wave of alternative reimbursements WellPoint is trying to spread across the country.

With a banner of its logo draped over the New York Stock Exchange on the Friday before St. Patrick's Day, Castlight Health went public, in another sign that reducing friction and opacity in healthcare is sparking a gold rush of sorts.

Depending on the outcome of a lawsuit Cigna is pursuing in Los Angeles, more out-of-network providers may be able to offer patients discounts while billing health plans in full.

With researchers expecting a lot of fluctuating eligibility between Medicaid and exchange subsidies among lower-income consumers, states and insurers will have to devise new ways to solve the problem of continuity of care disruptions.

The drug formularies of some small group health plans in two states don't meet essential health benefit benchmarks, a new study has found, leaving researchers pointing to a solution that may be as complex as benefit mandates.