Reimbursement

Americans in 2013 spent a little more on medical services from the prior year, but utilized them less, according to a new report by the Health Care Cost Institute (HCCI).

As of January 1, 2015, the U.S. Centers for Medicare and Medicaid will only be awarding payments to MA plans that receive 4 stars or higher.

Experts say directly comparing ACO models can be difficult because stakeholders often take different approaches to care management

Final notice from CMS changes the 1.9% pay cut to 0.4% increase, but that's only half the story

Prepare for a significant increase in self-pay liabilities from the “high-deductible“ patient population or risk a reduced level of reimbursement

CMS is driving down rates for MA plans while taxes and dwindling bonus pay pile on the pain

Get caught up on CMS proposals for Part D networks, mail order and price negotiations

SGR fix moves toward accountable care

Four key developments to watch for

Use telemedicine to increase provider reach

The medical community is using checklists to voluntarily cut costs

Pioneer and Shared Savings ACOs claim $274 million in payback for reducing costs

Cynthia Ambres of KPMG discusses the future of payment reform.

Even under innovative payment models, RBRVS is here to stay

Consider shifting to condition episodes and linking member benefits

CMS has increased the number of telehealth services it will reimburse under Medicare

New OIG report reveals dieticians and massage therapists prescribing drugs and says plans have obligation to verify claims

ACOs, bundled payment, shared savings require new capabilities and new culture

10 Things You Need To Know About ICD-10:ICD-10 presents payers with an opportunity to deliver more profitable and innovative care

Catalyst for Payment Reform has released a national scorecard describing the current state of value-oriented payment, finding that about 11% of commercial payments are tied to value

Extreme out of network fees and lack of transparency are threats to affordable care

According to AHIP, more claims are being received by payers in electronic formats, and payers are processing those claims at a faster rate than before.

More than $8 billion has been saved this year as a result of the American Medical Association's (AMA) Heal the Claims Process campaign

Looking at the next several years, administrative services only agreements appear to be the most profitable line of business.

Payers see a balance of power when it comes to rate negotiations.

Paul B. Ginsburg discusses how new payment models are progressing

Private payers have the most experience with managing risk, but each stakeholder must achieve a perfect balance of risk and reward.

Patient-centered medical homes (PCMHs) are gaining traction with increasing support from health plans, based on their promise to lower costs.

As the focus of managed care strategy includes implementing preventative initiatives, it is critical not to overlook vaccines.

To achieve a higher rate of clean claims, health plans have to be absolutely clear on what a "clean claim" means to all parties in the transaction.