Reimbursement

Left as-is, current exchange formulary and network search technology has the potential for a lot of consumer dissatisfaction and backlash.

Cooperative health plans attracted more than 400,000 Americans during the first open enrollment period and, although their long-term viability is still not guaranteed, some are bullishly plotting to grab market share from incumbents next year.

Not-for-profit hospitals are facing huge revenue challenges amid payment reform and shifting payer mixes, leaving relationships with commercial insurers in a flux.

Many not-for-profit hospitals are still struggling to align revenue with capital deployment and expenses, a challenge that may grow as patients come in covered by exchange plans and Medicaid.

So far, 2014 is not looking too shabby for some large insurers. Aetna, the Hartford-based giant, raised its outlook following a record quarter, but that doesn't mean there aren't headwinds.

A small uproar over provider networks in public insurance exchanges in Washington state has led to a proposed, controversial fix that, if adopted, has implications for other states, providers and insurers facing similar situations.

The billing (claims) data of healthcare providers for the United States Medicare Program, which is considered to be one of the most important healthcare programs to be held private for almost 35 years, was made available to the public just a couple of weeks ago on April 9.

The brains behind implementing much of the Affordable Care Act's new Medicare policies, Jonathan Blum, principal deputy administrator at the Centers for Medicare & Medicaid Services, will be stepping down from his position on May 16.

Midwest managed care insurer Centene is on a roll. It beat Wall Street's first quarter expectations, increased membership and has its eyes on a new international venture.

Many claims processing organizations rely on distributed workforces to save costs on office space, increase their access to labor, and have a broader talent pool to recruit out of. There are plenty of benefits of this approach, but there are also risks.