Reimbursement

As California goes, so goes the country in capping consumer costs for medicines? That's what patient advocacy groups and and some pharmaceutical companies may be hoping.

A national for-profit giant and Michigan's largest health insurer are coming to a resolution over the long-standing, fractious trade issues of excluding and favoring.

A mix of old and new school insurers are the best health plans in the eyes of the 59,000 physicians and providers using the digital billing and record-keeping services of athenahealth.

Jay LaBine, MD, is a surgeon working at the forefront of America's changing healthcare economy, the provider-sponsored health plan.

As giants like Blue Cross Blue Shield, Aetna and Humana target smartphone access, the payers must think hard about the kind of experience they're offering patients through an app.

The nature of the risk under the CMS Pioneer ACO and Shared Savings programs is hard for providers to manage. But the Next Generation ACO program has changed the level of risk, offering providers a higher share of savings and new ways to limit unpredictable losses.

The further reimbursement cuts are expected push margins of an estimated 40 percent of all home health providers into loss territory.

As dry as the decision may appear, insurers literally have millions of dollars on the line when CMS comes knocking. That makes picking the right auditor, and doing so the first time, absolutely critical.

The chief lobbyist for American health insurance is taking a job at a regional nonprofit insurer, after shaping a once-in-a-generation reform aimed at benefiting both the public and the industry.

It was only a matter of time until a big regional Blue Cross insurer got hacked, except that time was a year ago and security experts just recently uncovered it.