Revenue Cycle Management

Payer-Provider Providence St. Joseph Buys Blockchain RCM Company

February 18, 2019 - Providence St. Joseph Health (PSJH), an integrated payer-provider system, has announced the acquisition of Lumedic, a blockchain company serving the revenue cycle management market. The purchase will turn PSJH into the first payer-provider network to leverage blockchain at scale to improve the interoperability of data between financial and clinical...


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Hospital Price Transparency Rule Takes Effect January 1, 2019

by Jennifer Bresnick

Starting January 1, 2019, hospitals will be required to post their price lists online in an effort to increase price transparency and empower consumers to make informed choices about their care. The...

Addressing Healthcare Literacy Key to Health Plans Reducing Costs

by Chuck Green

The inability of consumers to successfully navigate the healthcare system, which costs employers and health plans billions in administrative costs. In a recent article in the Harvard Business Review,...

Medicare Advantage Evaluation Requires Transparent Claims Data

by Thomas Beaton

The growth of the Medicare Advantage (MA)  market requires the release of more claims data to evaluate the commercial and government impact of the program, according to a recent JAMA commentary...

High Care Costs Driving Employer-Sponsored Insurance Spending

by Thomas Beaton

The Health Care Cost Institute (HCCI) found that high care costs were the primary driver of increased employer-sponsored insurance spending in 2016, which grew by 4.6 percent and exceeded any rate...

IT Investment to Help VA Speed Claims Administration, Payment

by Thomas Beaton

The Department of Veterans Affairs (VA) has announced new goals for claims administration and a significant investment in health IT tools that will help coordinate payment for community providers. The...

Trump Plans to End Cost Sharing Reduction Subsidies for Payers

by Jennifer Bresnick

The White House has announced plans to scrap the Affordable Care Act cost sharing reduction subsidies for health insurers that have helped to keep premiums low and stabilize markets subject to the...

Competitive Bidding Curbs Medicare Durable Medical Equipment Costs

by Thomas Beaton

A research team from the Health Care Cost Institute (HCCI) found that the Competitive Bidding Program (CBP) lowered Medicare costs on durable medical equipment (DME), bringing spending down to levels...

Can Healthcare Payers Inspire ACOs to Take on Two-Sided Risk?

by Jennifer Bresnick

While two-sided risk arrangements are attractive for healthcare payers, even experienced accountable care organizations (ACOs) are wary of jumping into contracts which make them financially responsible...

PA Seeks Increased Payer Coverage of Emergency Air Ambulances

by Jesse Migneault

Emergency air ambulances save lives, but they can also leave patients in a mountain of debt.  Pennsylvania Insurance Commissioner Teresa Miller would like payers to shoulder more of the costs of...

UnitedHealth Grows by 11.8% Despite ACA Marketplace Withdrawal

by Jesse Migneault

Despite its very public near-total withdrawal from the Affordable Care Act marketplace in 2017, the nation’s largest healthcare payer recently reported substantial Q1 profit...

AHA Condemns CMS Rule for Medicaid Third-Party DSH Payments

by Thomas Beaton

The American Hospital Association expressed “deep disappointment” about a CMS final rule that will only include uncompensated care costs for covered Medicaid services in the calculation of...

Payers Face 9.6% Underwriting Loss on Health Insurance Exchange

by Jacqueline LaPointe

Underwriting margins for payers selling individual plans on the health insurance exchange dropped from a 6 percent earned premium loss in 2014 to a 9.6 percent loss in 2015, Milliman recently reported....

Emergency Coverage Top Healthcare Consumer Demand For Payers

by Thomas Beaton

A new poll from the American College Of Emergency Physicians (ACEP) and Morning Consult found that 95 percent of healthcare consumers say payers should cover emergency services. Out of the 1,791...

Experts Lay Out Strategy for Achieving Universal Coverage

by Thomas Beaton

Experts from the Harvard Business School, Duke University, and David Geffen School of Medicine at UCLA debate the viability of an individual mandate as a means of achieving universal coverage without a...

How Payers, Providers Could Streamline Medical Claims Management

by Vera Gruessner

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...

4 Ways Payers Could Improve Healthcare Price Transparency

by Vera Gruessner

Healthcare price transparency remains a key issue for health payers across the country. In order to strengthen member retention efforts especially during open enrollment periods, payers will need to...

Senate, House of Representatives Pass 21st Century Cures Act

by Vera Gruessner

This week, Congress passed the 21st Century Cures Act. President Obama signed the legislation into law on Tuesday, December 13. The 21st Century Cures Act passed with bipartisan support 94-5 in the...

How Health Payers Could Help Reduce High Out-of-Pocket Costs

by Vera Gruessner

A major problem still impacting consumers within the health insurance market is the potential for seeing high out-of-pocket costs. Many individuals are still underinsured despite the significant...

Rise in High-Deductible Health Plans Requires Cost Transparency

by Vera Gruessner

High-deductible health plans are becoming more and more common across the health insurance industry. With the many changes that the Affordable Care Act (ACA) has brought, payers are attempting to...