News

A challenge to a Blue Cross company's recoupment practices has ended in victory for a group of chiropractors and with a favorable precedent for providers who want to appeal the decisions of certain health plans.

In an era of increasing consolidation, some insurers are taking a slightly different route on the health reform journey.

Medicare may be overpaying hospitals an estimated $5 billion as a result of the 18-month moratorium on enforcing the controversial two-midnight rule that tells hospitals when patients should be admitted, according to an independent Medicare auditing company.

A new interpretation of a 40-year-old law could offer healthcare providers more options for appealing payer recoupments or preventing them altogether.

Disasters, natural and man-made, threaten more than hospital property. With many healthcare information technology systems integrated and focused on patient care, the threat of an IT or communications shutdown can be both dangerous to patients and costly to the health system.

While majorities of healthcare providers see value-based payment models becoming the reimbursement status quo in coming years, fewer than one-in-three say the reward is worth the risk.

Consumer concerns about new health plan networks continue, with two new members suing over a preferred provider network they say was deceitfully marketed.

As a payer and provider and the country's largest managed care organization with a lot of digital and online patient data, Kaiser Permanente has tried to address privacy and security head-on, and may pave a way for others.

As part of a contract extension with Tenet Healthcare, Cigna has established a first of its kind quality-based reimbursement agreement.

The corporate saga of a Medicaid managed care fraud case is coming to a close as three former executives head to federal prison, offering a cautionary tale for public benefits contracting.