Consumers today are becoming more and more responsible for covering the costs of healthcare services especially due to the greater proliferation of high-deductible health plans and out-of-pocket spending. What are the biggest healthcare...
Health plans, vendors, and providers will need to meet CORE certification requirements in order to comply with mandates under the Patient Protection and Affordable Care Act. CORE stands for Committee on Operating Rules for Information...
Four of the top five major payers in the nation are looking to consolidate into two combined health insurance companies. The Anthem-Cigna and Aetna-Humana health insurance mergers could lead to a complete transformation of the market and...
The expansion of value-based care reimbursement is making headway across US hospitals and clinics. To better prepare for the transition to value-based care reimbursement, IDC Health Insights, a healthcare IT consulting company, offers...
The health insurance industry may have a complete transformation on their hands with regard to hospital and medical practice reimbursement. The number of provider-sponsored health plans is growing among physician groups and hospitals,...
A major goal among health payers today is to decrease continually rising healthcare spending. One way to do so is to identify patients who are at higher risk of deteriorating medical conditions and looking to engage with their provider to...
The major health payer Humana will be moving toward adopting additional bundled payment models that will serve Humana Medicare Advantage members. The payer will be partnering with four orthopedic specialty establishments through these...
The Healthcare Effectiveness Data and Information Set (HEDIS) is used by more than 90 percent of all health plans situated around the country to compare performance and year-to-year success. HEDIS scores allow health plans to determine...
Last month, the Centers for Medicare & Medicaid Services (CMS) released proposed rules for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which will essentially drop meaningful use requirements in favor of the...
The health insurance industry has been undergoing tremendous reforms in recent years due to new federal regulations including the Affordable Care Act. Reimbursement between payers and providers have been changing as well. Coverage for the...
Earlier this month, the mobile technology company athenahealth released its annual PayerView Report, which delves into the complex and evolving relationship between payers and providers, according to a company press release. This report...
The state of New York is undergoing significant payment reforms within its Medicaid program. In 2014, Governor Andrew Cuomo finalized negotiations with federal agencies to create a waiver that would allow New York to renew $8 million in...
Blue Cross Blue Shield of Arizona (BCBSAZ) has recently partnered with McKesson Business Performance Services to form a service-based organization called ACO Partner meant to function in the evolving value-based care reimbursement...
Skilled nursing facilities are an essential part of improving the health among the elderly and the disabled. However, some skilled nursing facilities and rehabilitation centers have taken advantage of Medicare beneficiaries by fraudulently...
The future of the Affordable Care Act and health insurance exchanges may not be as favorable as the Obama administration had hoped. Many fear that the major health insurer UnitedHealthcare leaving the state-based exchanges could lead other...
Value-based care reimbursement including bundled payment models or accountable care organizations may help medical providers and payers achieve the Triple Aim of Healthcare which is better patient care, stronger population health outcomes,...
The Affordable Care Act has impacted a variety of aspects of the health insurance landscape as well as the healthcare delivery system. The Patient Protection and Affordable Care Act also led to the Center for Medicare & Medicaid...
Starting in January 2016, the Centers for Medicare & Medicaid Services (CMS) began reimbursing physicians for conducting end-of-life and advanced care planning discussions with patients who are Medicare beneficiaries. Doctors are able...
The Patient Protection and Affordable Care Act brought a variety of changes for the healthcare industry as well as individual states. For example, the Affordable Care Act called on for Medicaid expansion among the 50 states. However, a...
The Patient Protection and Affordable Care Act has brought a variety of changes for both insurers and healthcare providers with the establishment of health insurance exchanges holding a top place in reforming reimbursement between payers...
