Reimbursement

Medicare regulators are updating hospital outpatient and ambulatory surgery center payments for next year, and also outlining a potential remedy to private Medicare overpayments.

UnitedHealthcare's bid to change financial incentives for oncologists has led to some promising, though somewhat mixed results.

A new study says there's no need to worry about hospitals using their new electronic medical records to generate bigger bills and boost their income, but the study may not be checking the right data.

Joining its peers in touting accountable care, Cigna has met a fairly ambitious goal set two years ago, but more time is needed to test the strategy's sustainability.

One regional insurer is using a new approach in provider network management, as it aims to tackle a laborious administrative process.

One of the country's largest health insurers is being accused of having misleading information on doctor and hospital network participation for EPO and PPO plans sold in the state exchange.

Health care providers have long expressed dissatisfaction with the time they spend coordinating care with health plans and getting paid. Indeed, one of the most inefficient and costly processes for both providers and payers is Prior Authorization.

For Medicare contract sponsors to remain viable, it's now necessary to perform a comprehensive Medicare program compliance review. Proposed rule changes may give CMS additional authority next year.

With spending on diagnostics alone for cardiovascular disease likely to be a major challenge for insurers amid the baby boom wave, Aetna is turning to an emerging option as part of a strategy to avoid invasive tests and treatments.

If your modus operandi is to appeal all denied claims, you may want to reconsider because some claims are not worth it.