Health plans have traditionally used tiered formulary cost-sharing arrangements to reduce healthcare spending and incentivize appropriate medication use. But a recent Journal of Managed Care &...
Successful medical claims management and processing is not always easy to garner for health insurance companies due to a lack of training among insurance agents, missing or inaccurate...
Medical claims management is a key aspect of the payer-provider relationship. However, medical claims management tends to include multiple challenges for both payers and providers. Some of the problems...
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...
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...
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....
Health insurers and consumers can benefit from seeking reference pricing when it comes to choosing specific diagnostic tests among a set of different laboratories. Researchers from the University of...
Both public and private health payers have been searching for ways to reduce healthcare spending as a whole, but rising prices may be making it more difficult to combat medical care expenditure. The...
The Medicare program, Medicaid coverage, and the Children's Health Insurance Program are not the only public payers offering assistance to the American people. Veterans Affairs (VA) also...
The health insurance industry has been changing due to the Affordable Care Act and other regulatory pressures from the Centers for Medicare & Medicaid Services (CMS). Rising healthcare costs along...
Those who have spent time in a doctor’s office or emergency room may have seen that the prices of healthcare services tend to vary drastically among separate medical facilities. New findings from...
The trade association AMGA, which entails a large membership of medical groups and healthcare delivery systems, submitted comments last week to the Centers for Medicare & Medicaid Services (CMS)...
In today’s world, the average employee and business owner are seeing a rise in health insurance costs. Even through the health insurance exchange, premium prices are expected to rise this year...
Recently, the health payer Blue Cross and Blue Shield of Illinois (BCBSIL) announced in a press release that it will be extending its partnership with the American Lung Association of the Upper Midwest...
New technologies and health IT tools are becoming a necessary part of the health insurance industry, as innovative approaches like automation can largely benefit employees while portals could make a...
The Health Care Cost Institute (HCCI) announced today the publication of six different policy briefs entailing how state and federal regulations are affecting healthcare spending and patient services....
The fee-for-service payment model is slowly becoming an antiquated concept as more insurers and healthcare providers adopt value-based care reimbursement. Karen Ignani, President of Emblem Health and...
Despite the fact that the health insurance exchanges and Medicaid expansion opened up more opportunities for Americans to obtain healthcare coverage without being dependent on employment, the health...
At the Healthcare Financial Management Association (HFMA) National Payment Innovation Summit taking place February 10 to 12 in Memphis, Tennessee, a multitude of stakeholders gathered to share ideas...
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...
