Claims Processing

For the second year in a row, Humana ranked first in overall performance among 148 payers, according to the 2014 PayerView Report. The report ranks health insurers according to specific measures of financial, administrative and transactional performance.

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, sowing animosity between health systems and the feds.

A new interpretation of a 40-year-old law could offer healthcare providers more options for appealing payer recoupments or preventing them altogether.

With Medicare's "two midnight rule" set to take effect later this year and audit appeals facing lengthy backlogs, the Recovery Audit Contractor program may be headed in some new directions.

An unusual 90-day grace period for government-subsidized health plans may leave physicians at risk for not getting paid for their services.

The financial impact of the two midnights rule remains an open question and so is whether recovery auditors will challenge fewer claims or just shift their focus.

Despite the hassle of auto-cancellations, many home healthcare agencies find it difficult to keep track of their requests for anticipated payment.

There's still plenty of work to do before the Oct. 1 ICD-10 deadline. A recent study found that only 4.8 percent of physician practices reported significant progress in overall ICD-10 readiness. Hospitals report higher levels, but many are still behind.

Healthcare is one of the last bastions of consumer-unfriendly billing and pricing. As individuals start to take on more responsibility for premiums, deductibles and co-pays, they are increasingly demanding more transparency. And providers will be forced to respond.

Although highly touted, the patient-centered medical home model failed to lower use of services or total costs and produced little quality improvement over three years, research in the latest Journal of the American Medical Association has found.