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As Oregon transforms how it delivers care to 780,000 Medicaid patients, it hopes to generate better outcomes at lower costs. The problem is these goals conflict with hospital's traditional reliance on revenue from ER visits and inpatient stays.
Federal regulators are starting to finalize simmering ideas for public exchanges and also responding to consumer concerns, outlining a new quality rating system and proposals covering everything from narrow networks to loss ratios.
The days of cryptic invoicing are coming to an end for healthcare, or at it least they should be, financial experts say.
Hospital pharmacies can be huge sources of spending and also good sources of meaningful data. Healthcare Finance News talked to a data-driving hospital pharmacy director to learn how evolving analytics tools can help reshape clinical and financial approaches for the better.
The Medicaid and CHIP Payment and Access Commission is out with its biannual report, proposing a number of changes to eligibility, premiums and disclosure policies, including some intertwining with exchange health plans.
Several months of sustained legislative progress on physician payment reform has been stopped in its tracks by an add-on.
As Montana's Blue Cross company evolves under a new corporate parent, state regulators are penalizing it for some alleged past misdeeds uncovered by an audit.
The financial impact of the two midnights rule remains an open question and so is whether recovery auditors will challenge fewer claims or just shift their focus.
Anthem Blue Cross and Blue Shield in Colorado has convinced one-third of the state's primary care providers to join its value-based payment program, part of a wave of alternative reimbursements WellPoint is trying to spread across the country.
A House vote today may have derailed physicians' chances of finally getting Medicare's formula for paying doctors repealed.