By Mohammed Vaid – Penalties reduce revenue, but their real significance lies in what they reveal about payer operations. A single error in plan materials can cascade into thousands of disputes, costly claim adjustments, and delayed reimbursements.
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By Jay Eisenstock – Since 2021, the Hospital Price Transparency Rule has required hospitals to post prices for 70 common medical services so patients can compare costs and make more informed choices. The idea is that, just like shopping for appliances, competition can help reduce costs if patients are able to see the real prices.
Reported payers and health insurance industry news from Firstsource Solutions Limited, Independence Blue Cross, Anthem Blue Cross and Blue Shield, OhioHealth, Humana, CareSource, Oscar Health, and more.
By Todd Doze – Passed into law this July, the bill brings with it $930 billion in Medicaid cuts that are expected to cause nearly 12 million Americans to lose health insurance coverage, tightened Medicaid eligibility rules, and funding reallocations that will significantly alter how care is paid for and who gets covered.
Reported payers and health insurance industry news from Independence Blue Cross, Humana, Peach State Health Plan, Blue Cross and Blue Shield, CareSource, Medica, Cigna, and more.
Reported payers and health insurance industry news from Humana, AHIP, Anthem Blue Cross and Blue Shield, Cigna, CareSource, Independence Blue Cross, Aetna, and more.
By Devin Partida – Healthcare IT and accounting work hand in hand to provide patients with safe and affordable virtual services. Maintaining secure environments protects customer data and increases trust, encouraging people to return for more services when needed.
By Ritesh Ramesh – Healthcare finance executives face an intensifying storm of audits, denials, and clawbacks that threaten their organization’s financial stability. Couple that with an environment of heightened regulatory and payer scrutiny, and it becomes clear that proactive risk monitoring and AI-driven compliance strategies are no longer optional—they are imperative.
By Chris Lally – Over time, lawmakers, payers, and clinicians recognized that misaligned incentives produced waste, clinician fatigue, and uneven results. Value-based care (VBC) reshapes the equation by tying payment to quality, equity, and cost control. But how do you get there?