Providers

The Supreme Court of the United States ruled on Tuesday that providers cannot sue states over low Medicaid reimbursement rates, overturning the decision of the lower court.

More than $3 billion was returned to the Medicare Trust Fund in 2014 from individuals and companies attempting to defraud federal health programs, according to an announcement by HHS.

Keeping afloat by understanding the Affordable Care Act, managed care, consumerism, and transparency from the perspective of purchasers, providers, and consumers.

Public comments on the first ever update to the Medicare Shared Savings Program are in. Conceptually, there is an astounding level of consensus, but it is the details that can make or break an ACO.

When the first National Comprehensive Cancer Network Guidelines were developed 20 years ago, even the participating members who were there at the beginning were skeptical they would be able to come to an agreement and build something lasting.

During his keynote speech at the National Comprehensive Cancer Network (NCCN)'s 20th Annual Conference, Chief Executive Officer Robert Carlson, MD, spent the majority of his time discussing the NCCN Guidelines because they are the core of its services.

Blue Cross Blue Shield of Alabama and a large provider could not come to renewal terms, forcing 28,000 mental health patients to go elsewhere. Critics have said the episode is the latest in state's dismal record in mental health.

Starting with a contract that works for both parties involved is the best way to ensure payers and providers will work together, said Craig Thiele, MD, chief medical officer of CareSource.

Letting patients see their medical records while they're in the hospital might ease worry and confusion without extra work for doctors and nurses, a small study suggests.

In a 3-month review of cyber risk management practices in healthcare, the Health Information Trust Alliance (HITRUST) has found that the industry's approach is reactive, inefficient, and labor intensive.

While some progress has been made to disseminate comparative effectiveness research as mandated by the Affordable Care Act, the Agency of Healthcare Research and Quality has not taken actions to fully address requirements, according to a report from the Government Accountability Office.

On March 4 the Supreme Court will hear arguments in the case of King v. Burwell, which determines the fate of subsidies in the 34 federally facilitated marketplaces, and David Blumenthal, MD, chief executive officer of The Commonwealth Fund, outlined the potentially catastrophic effects if the Court were to side with the plaintiffs.

In a string of meetings and press releases, the federal government's health watchdogs have delivered a stern message: They are cracking down on insurers, hospitals, and doctors offices that don't adequately protect the security and privacy of medical records.

While California has made great strides to improve mental health prevention and early intervention, the state's Department of Managed Health Care found causes for concern regarding Kaiser Permanente's behavioral health services.

Eligible healthcare professionals participating in the Medicare Electronic Health Record (EHR) Incentive Program 2014 reporting year will have additional time to attest to meaningful use, according to an announcement from CMS.

Some of the challenges with bringing as much focus to the mental well-being of patients as their physical conditions has to do with problems the healthcare industry created itself, according to Robin Henderson, PsyD.

More than 375,000 Kentuckians signed up for the state's expanded Medicaid program in 2014, and doing so has saved Kentucky approximately $100 million, according to a new report.

A new study debunks the common assumption that high medical costs are a result of patients demanding more tests and treatments. Researchers analyzed more than 5000 patient-clinician visits and found that cancer patients rarely push for medical interventions.

Harvoni has shown results within the first 8 weeks of treatment, which would save costs, Matthew D. Harman, PharmD, MPH, does not think many patients or providers will be making cost-based hepatitis C treatment decisions.

Amid President Barack Obama's planned Precision Medicine Initiative, the FDA is evaluating its regulatory approach to next-generation sequencing.

Putting data in patient hands, the construction of an open API, and interoperability are big hopes for the future of health information technology (IT), according to panelists at the annual meeting of the Office of the national Coordinator for Health IT.

The Office of the National Coordinator for Health Information Technology has released the first draft of its interoperability roadmap to deliver better care through the exchange and use of health information technology.

Payers differentiate between predictive and prognostic diagnostic tests, and one is definitely more useful than the other, according to John L. Fox, MD, MHA, of Priority Health, and Bryan Loy, MD, MBA, of Humana.

A new private-sector alliance of healthcare systems and payers will dedicate to accelerate the US healthcare system's transition to value-based models aligned with improving outcomes and lowering costs.

An American Medical Association-led coalition of 35 medical societies has urged the Office of the National Coordinator for Health Information Technology to reevaluate the current electronic health record certification process.