Reimbursement

Deal gives provider ability to participate in the state's health insurance exchange with its narrow network.

Department of Health and Human Services says plans lacking substantial coverage of hospital and physician services don't qualify as "minimum value" coverage.

Medicare Advantage reimbursement and regulatory changes are coming, along with new probes into risk adjustment practices that could lead to settlements and clawbacks.

The federal government is extending the exchange sign-up deadline, due to concerns about tax season confusion and subsidy mistakes for some 800,000 Americans.

Connecting CFOs and clinicians on population health initiatives involves understanding how each group's environment influences decision-making.

While the new health insurance market is about as profitable as the pre-reform era for some large insurers, that is not the case for those like Assurant.

When CDC director Tom Frieden, MD, stated that neuraminidase inhibitors (NIs), such as Tamiflu, should be given to all elderly people with upper respiratory infection symptoms even before they have flu, I was appalled. Having read the Cochrane Review report on NIs, it seemed clear to me that at best Tamiflu was ineffective, and at worst it could cause more harm than good.

The industry has changed. What were strengths are now limitations, and new critical success factors have emerged. The status quo may be the path to extinction.

In January, the Department of Health and Human Services set a goal for 50 percent of all Medicare provider payments to be the result of value-based compensation models by 2018.

South Carolina might be an unlikely place from which to run a small healthcare empire, but the state's oldest health insurance company is doing just that.