When it comes to oncologists following a set protocol for cancer care, should health payers have a say in the type of pathways these physicians need to follow? An opinion piece from JAMA Oncology seems...
Health information technology continues to be an elusive field for the payer industry, as some insurers still have difficulty with adhering to key technological advancements and data security...
The health insurance exchange system set up through healthcare.gov needs to be a robust technological platform in order to manage the vast amount of information and high enrollment numbers associated...
With the medical industry focused on population health and the need to stabilize rising costs, it is no wonder that more healthcare providers and payers are negotiating managed care contracts. When...
With January 1, 2016 only days away, it is useful to review next year’s predictions for the healthcare insurance industry. Both the costs of monthly premiums and the health insurance marketplace...
Last week, the Centers for Medicare & Medicaid Services (CMS) announced the release of an online dashboard that reports the amount of funds Medicare spends on prescription drugs. The drug spending...
On October 1, 2015, healthcare providers and payers across the entire nation switched over to ICD-10 diagnosis coding and left the ICD-9 coding behind. Today the ICD-10 diagnosis coding system is being...
When it comes to managing the treatment and financial implications of complex medical conditions, health payers and providers will need to work together and have effective cross-industry communication....
In recent months, four major players in the health insurance market have come together to form two separate mergers. The Aetna-Humana and Anthem-Cigna mergers have caused significant uproar among...
When it comes to data collection and data sharing, payers should inform beneficiaries exactly how their information is used such as public health reporting requirements or among healthcare providers....
The health insurance industry is experiencing some significant transformations not only due to new policies under the Patient Protection and Affordable Care Act but also because of upcoming health...
A common healthcare service provided to many patients with chronic medical conditions is the typical checkup from a visiting home nurse. One medical company called Heal is giving patients a step up...
As the year is coming to a close and many are getting ready to celebrate the holidays, it is important to look toward the coming year and prepare for healthcare insurance trends expected to impact the...
The Merit-Based Incentive Payment System (MIPS) is a new reimbursement program used by the Centers for Medicare & Medicaid Services (CMS) that has its own unique set of challenges and advantages...
The creation of health insurance exchanges throughout individual states after the passage of the Affordable Care Act has not been an easy process. Many state health insurance exchanges have experienced...
Before the Patient Protection and Affordable Care Act came into play, the United States was spending much more money on healthcare than many other first world countries. Despite high levels of US...
Currently, there is a healthcare coverage crisis taking place for state employees in Illinois. CBS reports that the state of Illinois is having major complications related to keeping its budget intact....
The October 1st ICD-10 transition deadline has passed and the healthcare industry still seems to be holding steady. However, only time will tell whether healthcare payers and providers...
As healthcare payers adjust their business models to more cleanly align with the continuously evolving ICD-10 landscape, immediate concern is being placed upon where payers should...
Claims management – the art of consolidating, billing, filing, revising, and managing medical claims – is an imperative aspect of the healthcare industry. Medical facilities cannot receive...
