By Jocelyn Keegan – Healthcare technology policy, especially rules impacting payers, are coming at us at a fast and furious pace coupled with new enforcement teeth. Executives and leaders in payer organizations face a pivotal decision — Do they simply fulfill regulatory compliance requirements, or do they…
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By Jason Brown – From initial claim submission to filling additional documentation requests, and responding to payer audits or denials, healthcare provider organizations dedicate significant time and resources to collaboration with payers.
By Lynn Carroll – The dramatic loss of revenue by healthcare providers during the COVID-19 pandemic was a sobering reminder that healthcare organizations rely on the traditional FFS revenue model at their own peril. In response, more provider groups are implementing APMs built around financial incentives.
By Michael Drescher – Health care has benefitted tremendously in the past decade from the explosion of data of all kinds. From more accurately identifying and tracking trends in care delivery, to developing the ability to predict the likely onset of disease, to documenting the real-world effects of…
By Patty Hayward – The healthcare payer space has shifted radically in recent years, with evolving reimbursement models, the rise of healthcare consumerism, advances in technology, and a global pandemic that upended businesses.
By Matthew Albright – The issue of surprise billing has long plagued the U.S. healthcare system. The need for legislation to protect individuals from surprise billing is strikingly clear, as studies reveal that one in five emergency room visits result in an unexpected bill for patients.
By Susan Bellile – As we kick off 2022, one of the big questions surrounding interoperability is the status of the payer-to-payer data exchange rule. The requirement was part of the May 2020 Final Rule supporting the 21st Century Cures Act, and its enforcement was scheduled to start on January 1. However, in September CMS delayed enforcement pending future rulemaking.
By Teresa Younkin – As we start rolling up our sleeves to get to work in 2022, we already are seeing several trends that will continue to transform healthcare in the year ahead. Payers will have their work cut out for them and will be forced to adapt, with many modifications coming sooner than later.
By Mark Menton – The sometimes adversarial relationship between providers and health plans is well documented – and its patients who end up in the crosshairs of the fragmented healthcare system. Amid government mandates, evolving customer demands, and rapid-fire innovation, many providers and plans realize they can’t go it alone anymore.