Health insurance companies are slowly moving toward adopting alternative payment models based on pay-for-performance metrics. This means more payers and providers are focused on meeting HEDIS quality...
In order to reduce ever rising healthcare costs, health insurance companies will need to improve price transparency among their health plans as well as within their provider networks. The Robert Wood...
Healthcare payers have often struggled to process claims and provide effective customer service in a more streamlined manner due to technological inefficiencies. Insurers have faced challenges with...
Health insurance companies, employers, and the workforce take a number of different steps to ensure that the best decisions are made in terms of health plan policies and covered benefits. For a variety...
Families and individuals who have purchased healthcare coverage on the ACA health insurance exchanges may have seen that monthly premium rates are expected to rise 25 percent in 2017, but should be...
With the healthcare industry continually reforming toward better patient outcomes and reduced medical spending, health insurance companies have been moving away from fee-for-service payment structures...
In the healthcare industry’s move toward value-based care reimbursement, public and private payers create healthcare quality measures meant to align with how providers are paid and what type of...
New proposed changes to current legislation from the Massachusetts Department of Public Health may either decrease the use of or potentially eliminate ambulatory surgery centers, according to a press...
Healthcare payers are being instructed to offer standardized plan and benefit designs as the federally facilitated health insurance marketplace is working to improve consumers’ ability to...
Health insurance companies are often looking for key methods and best practices to reduce rising healthcare costs. Payers could avoid the continual increase in medical spending by reducing the rates of...
When health payers and providers utilize health information exchange, they will make significant gains in reducing healthcare spending, reducing duplicative testing and services, and improving their...
More and more healthcare associations have been emphasizing the need to incorporate unique device identifiers (UDIs) from medical devices within health insurance claims. In fact, professionals from The...
The Health Care Cost Institute released new findings that show consumer-driven health plans are leading individuals to utilize less medical care as well as spending more on out-of-pocket costs. Among...
Some employers are finding it difficult to keep contracting with their health payers due to continually increasing monthly premium costs and a general lack of price transparency across the health...
With more health payers such as UnitedHealthcare, Humana, and Aetna dropping out of a number of state health insurance exchanges, it is useful to analyze the differences of healthcare coverage between...
Healthcare payers may find that they may no longer have to pass on extraneous costs to their consumers when out-of-network providers send more costly claims their way. New legislation in states like...
When it comes to medical claims management, healthcare payers and providers will need to communicate more effectively so that both parties are on the same page when it comes to claim denials....
Due to the many new transformations taking place within the healthcare industry today such as the transition from fee-for-service reimbursement to value-based care payments, the potential for creating...
With many health payers experiencing significant challenges while operating through the health insurance exchanges and adhering to various provisions of the Patient Protection and Affordable Care Act,...
HEDIS quality measures are managed by the National Committee for Quality Assurance (NCQA), which allows consumers to compare the quality of health plans among more than 90 percent of health payers...
