Reimbursement

Changes to care delivery and payment models need to happen in order to improve a cancer care delivery system that is in crisis, found a new Institute of Medicine report.

Cancer care delivery is a system in crisis, with escalating costs, an increasingly aging population and complex treatments for a difficult disease stretching healthcare resources, according to a new Institute of Medicine report.

With profligate use of CT and MRI scans widely blamed for increased healthcare spending, a new report shows that pairing automated prior authorization with evidence-based guidelines can ensure such tests are only used when necessary, improving patient safety while reducing medical costs by perhaps 40 percent.

Three healthcare executives shared the success factors that can propel shared savings and accountable care organizations and the pitfalls that can sink them, even as these value-based models are still in their infancy.

One of the first Affordable Care Act policies to take effect, the insurance medical loss ratio, has taken a bite out of profits in individual market businesses, but with less dramatic impacts to group health plans.

While public confusion over the Affordable Care Act continues, according to a recent Kaiser Family Foundation survey, Americans tend to trust some sources of information more than others -- including clinicians still grappling with the law's ramifications.

It's no secret: The U.S. healthcare environment is changing swiftly and dramatically. Healthcare organizations are steadily moving away from longstanding, traditional fee-for-service models to value-based care and reimbursement models.

Nurse practitioners say efforts to expand primary care to millions of Americans under the health law are hampered by insurance industry practices that limit or exclude their participation.

Mississippi's Insurance Department will likely be running the small business portion of the otherwise federally-managed insurance exchange serving state residents -- even as the insurance commissioner and other state officials make it clear they're not fond of the rest of the Affordable Care Act.

Contractors hired by Medicare to audit the payment records of healthcare providers have a good track record spotting improper billing, the HHS Inspector General concluded in a recent report, but legitimate concerns about their efficacy exist.