Healthcare Reimbursement

Cautionary tales: Why some payer-provider initiatives have stumbled

Health system leaders that are considering launching a provider-sponsored health plan can take a lesson from the experiences of organizations that faced challenges in pursuing such a strategy.

By Richard Weil, PhD January 10, 2020

Many voters oppose giving government authority to set all healthcare prices

More voters oppose broad government rate-setting than support such an approach to addressing healthcare cost increases, according to a poll.

By Rich Daly January 9, 2020

More physicians shift from MIPS to APMs in Medicare

Increasing numbers of physicians paid by Medicare are shifting from the default quality-reporting-based payment option to earning bonus payments by participating in other payment models.

By Rich Daly January 8, 2020

Limits on savings from bundled payments identified in new research

Bundled payment program savings appear limited to lower joint replacement, and changes may be needed to improve the programs, according to new research.

By Rich Daly January 7, 2020

CMS extends comment period for health plan price transparency rule

CMS will accept feedback for an additional two weeks on a proposed rule requiring health plan price transparency.

By Rich Daly January 6, 2020

Auth-DP software helps streamline prior authorizations to reduce denials

A leading revenue cycle technology company talks about how its innovative prior authorization software streamlines the process of checking for, obtaining and following up on prior authorizations, saving organizations millions in avoided denials.

By HFMA January 2, 2020

Payer-provider partnership success stories

Partnering with a health plan has been shown to be an effective strategy for health systems undertaking a value-based payment strategy.

By Richard Weil, PhD January 2, 2020

A tailored approach to value-based care product development

To be successful, a value-based-payment initiative must be tailored to the provider organization's market and capabilities.

By Richard Weil, PhD January 2, 2020

A closer look at healthcare payment methods

A short description of payment methodologies offers context on the argument about whether fixed fees are preferable to percent-of-charge provisions.

By William O. Cleverley, PhD January 2, 2020

Why removing percent-of-charge provisions in managed care contracts won’t address concerns about high hospital charges

Removing percent-of-charge provisions in favor of fixed fees would not remove the factors that drive price increases, nor would it reduce administrative hassles or decrease risk.

By William O. Cleverley, PhD January 2, 2020
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