Ask the Experts: Cost Sharing Programs
I am looking for more information about how to manage patients covered by cost sharing programs.
Medicare Advantage Rates, Policies Draw Insurer Praise
April 3—Medicare Advantage (MA) plans received an unexpected pay boost and generally beneficial policies in the final call letter and rules issued this week for 2019.
March 19-23 Policy Watch: Push to Include ACA Marketplace Stabilization in Funding Bill
March 15—Healthcare leaders are renewing their push to include a stabilization measure in a must-pass federal funding bill that is required by the end of next week.
How One ACA Insurer Had Its Best Year in 2018
March 6—In a year when individual-market insurance enrollment dipped nationally, the dominant insurer in Florida had its largest enrollment yet.
Short-Term Limited Duration Insurance Proposed Rule
This document summarizes the proposed rule published by The Departments of Treasury, Labor, and Health and Human Services amending the definition of short term, limited duration (STLD) insurance for purposes of its exclusion from the definition of individual health insurance coverage.
Ask the Experts: Payer Preference for Imaging Centers
Our hospital is beginning to feel the sting of payers steering their members from scheduled high-end imaging procedures at our facility to free-standing imaging centers. How are other hospitals and health systems responding to or reacting to this practice?
Ask the Experts: Managed Care Contracting Benchmarks
Do you know of other avenues besides our state Department of Insurance that we can pursue to resolve health plan payment issues?
Ask the Experts: Managing Health Plan Overpayments
I have heard there is a rule that health plans cannot recoup overpayments that are more than one year old. Does that stipulation vary by state, or is that a rule that is negotiable per contract?
Optimizing the Preauthorization Process
Senior healthcare provider and health plan leaders examine the difficulties associated with preauthorization and offer strategies for how stakeholders can collaborate to optimize the process.
The Hospital’s Expanding Authority over Authorizations: The Good, the Bad and the Reality
Heather Kawamoto underscores the need for hospitals to improve on the slow manual process of requesting authorizations as they take on this responsibility.