Policy and Legislation

Aug 23 | Susan Morse

Centene, Aetna protest losing Louisiana MCO contracts worth billions

The Centene subsidiary, Aetna and three other MCOs were paid $7.6 billion by Medicaid to cover more than 1.7 million…

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Aug 23 | Susan Morse

AHIP supports a federal model of California law to end surprise billing

Following adoption of the legislation, the number of physicians in provider networks increased by 16%.

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Aug 22 | Susan Morse

HHS proposes substance use disorder regulatory reforms to increase sharing of information

Current regulations are so complex that some providers opt not to serve substance use disorder…

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Aug 22 | Jeff Lagasse

Kidney transplants covered by Medicaid increased in states after Medicaid expansion

Preemptive kidney transplants covered by Medicaid have shown much greater increases in expansion states.

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Aug 15 | Jeff Lagasse

Majority of providers fall short of compliance with HIPAA access requirements

The primary reason for noncompliance was that most providers don't send records electronically even when so…

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Aug 15 | Susan Morse

Insurers' collective premium rate increases are less than 1% for 2020 ACA plans

Numerous states reported requested rate decreases and only three have double-digit increases.

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Aug 14 | Susan Morse

Pharmacy benefit managers keep less than 1% percent of rebates for Medicare Part D drugs, GAO says

Part D plan sponsors mainly used five PBMs in 2016: CVS Caremark, OptumRx, Express Scripts,…

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Jul 31 | Susan Morse

HHS and FDA propose plan for importation of prescription drugs from other countries

Manufacturers have wanted to offer lower cost versions but were locked into contracts with other parties…

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Democratic candidates take the stage during first debate in June.

Jul 31 | Healthcare Finance Staff

In Wednesday's second Democratic debate, 7 of 10 candidates support Medicare for All

Expanding coverage, lowering healthcare costs, central to Democratic agenda.

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DETROIT, MICHIGAN - JULY 29: The Fox Theater and surrounding downtown area is prepared for the Democratic Presidential Debate hosted by CNN on July 29, 2019 in Detroit, Michigan. The debate, which will take place on July 30 and 31, will feature the top 20 Democratic candidates. (Photo by Scott Olson/Getty Images)

Jul 30 | Jonah Comstock

Where Tuesday's 10 Democratic debaters stand on healthcare

Tonight, 10 out of 20 Democratic primary contenders will take the stage at ...

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Featured Resources

Care Collaboration Success for Improved Outcomes The nature of our healthcare ecosystem has been one of siloed care. Rarely do payers, providers and local resources come together with the patient's well-being prioritized as a unifying mission. Read how these organizations are getting it right.

Debunk the Myth: Outsourcing Doesn't Mean Losing Control With shifts in payer mixes and reimbursement structure, the margin of reimbursement has been shrinking steadily over the last five years. How do revenue cycle leaders navigate payment reform while maintaining stable business office operations?

Beyond Dollars and Cents: A Closer Look At Value Beyond the expected improvement in specific metrics, many organizations that outsource RCM with a trusted and certified partner are seeing several ancillary benefits of such agreements.

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Analyze this: Health systems, health plans get to the core of big data Pamela Peele knows that people who subscribe to cooking magazines have a much higher risk of going to the emergency room. But how she knows that is a whole other story.

Healthcare mergers and acquisitions in 2016: Running list While 2015 was a record-breaking year in healthcare mergers and acquisitions, 2016 saw more change as organizations across the industry adjust and adapt to the evolving financial landscape.

Once-failing hospitals say accountability, transparency key to surviving fallout from failing patient safety grades When Leapfrog released their Spring 2016 patient safety grades recently, 15 hospitals got slapped with a very public 'F' grade casting a spotlight on them that no institution wants. ...

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Credible, Defensible Estimates In healthcare, every interaction with the patient matters. Especially in today’s environment of continuous improvement, efforts have been concentrated on coordination among providers, the patient care experience and quality outcomes – all laudable goals.

Clinical Quality Measures 101 Although quality-reporting programs such as meaningful use provide incentives to help providers implement and use electronic health records (EHRs) to collect and report on clinical data, practices often need help deciding what data to collect, which measures to report ...

Gaining Actionable Insight into Financial Systems and Areas Impacting the Revenue Cycle Hospital systems across the country are looking to streamline their billing and collection processes to become more efficient and better compete in their markets. The challenge many face is how to turn the data ...

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