Reimbursement

For outpatients who receive care on both Sept. 30 and Oct. 1, the challenge will billing under both ICD-9 and ICD-10 diagnostic coding vocabularies.

In their ongoing efforts to manage costs and improve profits, many health plans are turning to the area of claims payment integrity, seeking opportunities to reduce annual claims expense by millions of dollars.

The Blue Cross Blue Shield brand may bring the idea of a consistent kind of health insurance, as the winner of one "health plan brand of the year" poll. But in Medicare Advantage satisfaction ratings, that is not the case.

Just as rival Humana exits the market, UnitedHealth Group is growing its portfolio of retail health clinics, in another step towards insurer-owned healthcare delivery.

The Centers for Medicare and Medicaid Service said the final revenue increase was driven by a spike in Medicare fee-for-service spending per capita estimates.

Moving beyond the 2014 "land grab," insurers in 2015 relied upon tried and true direct marketing approaches for member acquisition. Like the first open enrollment period, it seems for many, this was effective.

Hospitals see the proverbial writing on the wall, and are preparing for the industry transition to value-based purchasing. But under a value model, many organizations will struggle, at least initially, to maintain their margins and to retain adequate market share in their regions.

A 2008 federal law was supposed to ensure that when patients had insurance benefits for mental health and addiction treatment, the coverage was on par with what they received for medical and surgical care. But until now, the government had only spelled out how the law applied to commercial plans.

For the third year, regulators have revamped reimbursement reductions into an average increase for Medicare plans serving America's growing senior populations, though not without requiring more work and oversight.

Issue raises concerns about how well the insurance marketplaces can handle the flux.