PayerHHS-OIG Says Highmark Senior Health Upcoded $6.2M
The payer disputes an audit finding that 70% of the diagnosis codes submitted for 'high risk groups' in 2016 and...
Revenue CycleThey were turned away from urgent care. The reason? Their car insurance
Frankie, then a high school junior, worried that she might have a concussion that could affect her performance on an...
PayerInsurers Negotiate Lower Prices for Exchange Plans than Commercial Group Rates
Analysis of price transparency data suggests better information on health insurance exchange plans (HIX) is needed.
Revenue CycleNo Surprises Act Final Rule Addresses IDR Process, Downcoding
Several federal agencies issued a set of final rules based on the No Surprises Act aimed at making it easier...
PayerDigital Therapeutics: Beyond Coding to Coverage and Evidence Frameworks
"Particularly for payers now, you need to show economic outcomes and savings," says one company founder.
FinanceEnvision Healthcare Sues United Over Emergency Care Payments
"Fighting for patients? lives should not include fighting to get paid," says Envision Healthcare CEO Jim Rechtin.
PayerDraft chapter details Medicare’s projected financial future, MedPAC members concerned
Members of the Medicare Payment Advisory Commission (MedPAC) gathered for a presentation by MedPAC senior analyst Rachel Burton, MPP, and...
PayerThe New TPA Dynamics as HCSC Hauls in Trustmark
The recent acquisition will convert HCSC from customer to owner of the ninth largest third-party administrator (TPA) in the U.S...
PayerHealth Plan IT Execs Break Down the Platform-Industrial Complex
Leaders from three very different organizations discuss the rapidly changing state-of-play surrounding platform strategy.
PayerThe Two Healthcare Doors That Will Drive Disruption
Stakeholders from five countries identify critical digital transformation connections in the 2022 HIMSS survey.
PayerSlowing Economy, Inflation Could Challenge Payers
The potential impact is considered "relatively modest" as the industry is better positioned than it was during the 2008 recession.
TechnologyWalmart Joins New Radiology Data Quality Program
The national retailer is the first large employer to join the Quality Care Collaborative, which supports quality improvement in radiology...