Reimbursement

Two health plans are being barred from further enrollment and another is being warned, as state regulators act on promises to ensure access and quality standards for beneficiaries.

The long-standing problem of hospital-acquired infections, adverse events and medication errors is improving, new data suggest, although 1 in 25 hospital stays still comes with an infection.

Here's a point of view guaranteed to upset those who religiously believe (nothwithstanding structural flaws) that the move to accountable care organizations with an accompanying shift of risk to providers is the way to transform the U.S. healthcare system.

For payers that offer Medicare, Medicaid and hybrid government-sponsored plans, the regulations established by the Centers for Medicare and Medicaid Services present significant challenges in generating customer communications that are compliant as well as effective.

As some states try to overhaul their programs for Medicare-Medicaid eligible beneficiaries, Indiana is turning to managed care plans to improve services.

After a year's worth of negotiations, a large health system is testing the limits of its clout and leaving a Blue Cross Blue Shield network, amid allegations of unfair reimbursement.

Seniors living in three states will now need prior approval from Medicare before they can get an ambulance to take them to cancer or dialysis treatments. The change is part of a three-year pilot to combat extraordinarily high rates of fraudulent billing by ambulance companies.

A surge in health insurer competition appears to be helping restrain premium increases in hundreds of counties next year, with prices dropping in many places where newcomers are offering the least expensive plans.

The case for collaboration in accountable care networks is getting a boost in the Puget Sound (Wash.) region.

The case for collaboration in accountable care networks is getting a boost in the Puget Sound region, where Humana had found a partner for a new Medicare Advantage network.