Reimbursement

Just like that, the massive code set conversion won't happen before Oct. 1, 2015 unless President Obama derails the legislation.

New York is poised to solve one of the most pernicious consumer healthcare billing problems, and regulators think it could be a model. But for insurers, the new process may or may not be the ideal solution, especially when paired with new network requirements.

A group of chiropractors went to war with the Blues and it seems they've won, successfully using a novel legal theory that now has lawyers setting their sights on other large insurers.

Kaiser Permanente is hiring an integrated care specialist but organizational outsider as its new chief medical officer, as the focus on innovation comes to the fore.

As the Affordable Care Act continues to disrupt the health insurance industry, health plans must broaden their definition of risk as they calculate rates and attempt to better understand their members' needs.

The House of Representatives passed a bill yesterday to forestall scheduled cuts to Medicare physician payments through April 1, 2015, to delay the ICD-10 implementation deadline for one year, and to suspend enforcement of the controversial two-midnight policy.

As the quality and cost transparency movements gain support within the healthcare industry, a more important question persists: what will actually work for consumers?

The "cost to do business" doesn't have to be so expensive for government-sponsored health plans. Most payers are overspending on their annual print and fulfillment budget for member communications by 10-15 percent.

The many moving parts in the government's ACA plan transition policies are creating a range of new complexities for premium pricing, member pools and the new risk-sharing programs.

All but five states received a failing grade this year on the way they provide healthcare price transparency, according to a report by Catalyst for Payment Reform and the Health Care Incentives Improvement Institute.