Reimbursement
The Department of Health and Human Services has asked the University of Miami Hospital to pay back $3.7 million to Medicare for incorrectly billed inpatient claims uncovered in an audit but the hospital is disputing the government's calculations.
Almost 50 million Americans were uninsured as of 2011 and, what's more, a projected 71 million are expected to purchase insurance between now and 2018 via the new health insurance exchanges.
Never has Medicaid been in such a state of flux, with dozens of new policies evolving in the states in response to delivery and financing challenges, as millions more Americans join the program.
Physician group practices are hesitant to participate in the health insurance exchanges because they worry about payment collections and lower reimbursement rates, according to research from the Medical Group Management Association.
Humana Inc. is testing the use of an enhanced medical alert system with its Medicare Advantage members to prevent serious long-term effects of medical emergencies and falls.
Amid what the Kaiser Family Foundation calls "some of the most significant changes to Medicaid since its enactment," California Medicaid policy is evolving at perhaps the quickest pace, trying to manage the $55 billion in annual spending.
The quality of care that patients receive in a hospital varies by the type of insurance they have or their lack of insurance, researchers have found in a study in the latest issue of Health Affairs.
Predicting anything in healthcare is difficult, but one factor is a fairly good indicator of whether providers joined a Medicare accountable care organization: integration.
The growth in Medicare per capita spending is slower as a result of fewer hospital readmissions and a shift to generic prescription medications, and Medicare Advantage plans are also beginning to contribute to the moderating trend.
Even as access to behavioral and mental healthcare expands under health reform, there may still be gaps in both public and private insurance, researchers said in a new Health Affairs study.