payers
publication date
Finance
Bad Debt Grows as Out-Of-Network Benefits Shrink
A lack of OON benefits leads to never-ending financial obligations for patients and a greater likelihood of bad debt for...
DOJ Indicts 4 Florida Men in $1B Telemedicine Fraud Conspiracy
Private payers, including Blue Cross Blue Shield of Tennessee, were bilked out of about $174 million in the compounding pharmacy...
Finance
Navigating the Medical Necessity Battleground When Payers Balk
When claim denials result from factors like ineligible members and untimely filing, there's often little to argue. Medical necessity, though,...
Strategy
Why Texas Hospitals' Urge to Merge Takes Precedence
Health system M&As may be necessary as insurers with greater access to capital are expanding low-cost outpatient centers into Texas...
Finance
Tech Startup OODA Working With Insurers Toward Real-Time Claims Payments
Giving patients the capability to pay for healthcare upfront is typically hamstrung by the claims process. OODA Health aims to...
Clinical Care
3 Ways Providers can Improve Healthcare Access in Rural Areas
Rural healthcare providers can pursue multifaceted strategies to improve care availability, accessibility, and affordability.
Finance
Anthem's ER Policy: HHS Response Leaves Senator Unsatisfied
A lawmaker behind the 'prudent layperson' standard has been pressing HHS, DOL, and CMS for progress reports on what he...
Finance
Top Risk Models Healthcare Orgs Use for Population Health. How Do You Compare?
The general trend demonstrates a preference for structures with shared risk in the near term, with a gradual move toward...
Finance
Doctors Sue Anthem Over 'Dangerous' ER Coverage Policy
The insurer implemented its policy in six states over the past year, leaving patients on the hook for bills Anthem...
Finance
4 Tips for Keeping Up with Payer Changes
Engaging in 'denials management' rather than 'denials prevention' is a costly approach.
Finance
Healthcare's Next Cost Challenge: Tackling Rising Prices
The employer medical cost trend has stabilized at about 6% annually through 2019, but that's still unsustainable and well out...