Reimbursement

With millions of Americans on new exchange plans now responsible for high deductibles, hospitals, drug makers, insurers and regulators are entering a new frontier of payment disputes.

Healthcare payers have made great strides to improve claims errors and drive down costs. The AMA's 2013 National Health Insurer Report Card recently found a significant reduction in the claims error rate to an average of seven percent among the nation's largest commercial health insurers. But there is still work to do.

As more exchange enrollment data emerges, so too is a premium strategy that in the long-run may act as a market check of sorts.

Highmark is changing its CEO for the third time in as many years. An executive whose work spans jewelry, fabrics and eyeglasses is taking the helm of a new integrated payer-provider in the early stages of a market war.

Bundled payments represent a new and increasingly accepted form of reimbursement. They can work now, if applied in modest, manageable ways from which lessons can be learned and applied more broadly later.

Hospital ownership of physician practices appears to lead to statistically and economically significant increases in hospital prices and spending, according to a recent study published in Health Affairs. But that doesn't mean providers should retreat from integration and tighter alignment.

The breakthrough hepatitis drug Sovaldi has sparked a vigorous debate about the financial sustainability of U.S. healthcare and the role of government in regulating prices.

A challenge to a Blue Cross company's recoupment practices has ended in victory for a group of chiropractors and with a favorable precedent for providers who want to appeal the decisions of certain health plans.

In an era of increasing consolidation, some insurers are taking a slightly different route on the health reform journey.

Medicare may be overpaying hospitals an estimated $5 billion as a result of the 18-month moratorium on enforcing the controversial two-midnight rule that tells hospitals when patients should be admitted, according to an independent Medicare auditing company.