Reimbursement

Covered California, soon to be the nation's largest state insurance exchange, is touting the relatively low premium rates tentatively secured for individual health plans -- but HIX officials are comparing those to existing small group market rates, which isn't entirely apt.

Claims overpayments are more than a nuisance; they are an epidemic. Between $68 and $226 billion is lost annually to Fraud, Waste and Abuse (FWA), according to the National Health Care Anti-Fraud Association (NHCAA). As much as 10 percent of healthcare spending is attributed to abuse alone, with the federal government losing more than $70 billion to improper Medicare and Medicaid payments in 2010.

In the first disclosure of individual health insurance premiums by the nation's largest state, California announced on Thursday a wide array of choices for the 5.3 million people expected to qualify to purchase coverage through its online marketplace established by the Affordable Care Act. 

Health insurers in Oregon, one of the nation's most competitive markets, have proposed premium rates for 2014, as most prepare for what may be even more competition in the state insurance exchange.

The Centers for Medicare & Medicaid Services has finalized medical loss ratio regulations for Medicare Advantage and Medicare prescription drug insurers, allowing some EHR and ICD-10 set-up costs to be counted as quality improvement and also a range of deductible community benefit expenditures.

A study containing mixed results of the effects of increased Medicaid enrollment in Oregon offers some caution about expectations for dramatic improvements in the health of millions of individuals from just expanding coverage across the nation in 2014, according to one of the authors of a recent study.

Federal employees with the Blue Cross and Blue Shield Association's health plan will soon have access to personalized health management tools like risk assessments, online health coaching and a 24/7 nurse advice line.

Emergency departments are now responsible for half of all inpatient admissions and accounted for nearly all the increases in admissions between 2003 and 2009, according to a new report from Rand Corporation.

The Texas Supreme Court has denied an attempt by 14 hospitals to force the state Health and Human Services Commission to recalculate and repay the difference on past Medicaid claims.

With hospitals nationwide feeling the burden of Medicare penalties for avoidable 30-day readmissions, C-suite managers have been frantically searching for ways to pinpoint these high-risk patients early on. A recent analysis suggests a low-cost and simple scorecard that detects one out of four of these patients.