The unknowns of Operating Rules

Vijay Bhuttar, Edifecs

2015 is going to be yet another busy year for health plans with the ICD-10 cutover scheduled for October and Operating Rules penalties (still in the rulemaking process) kicking in on January 1, 2016.

GOP has a plan if the SCOTUS guts ACA subsidies?

Robert Laszewski

The simple assurance that Republicans have a plan to avoid any major disruption to Obamacare from an adverse Supreme Court ruling may not be so simple.

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The Obama Administration recruited Seattle Seahawks quarterback Russell Wilson and cornerback Richard Sherman to the game of selling the Affordable Care Act.

President Obama acknowledges the technical issues with HealthCare.gov, pledging his Administration will resolve them soon and asserting that the distressed web portal is not the only way to shop for affordable health insurance available through the ACA.


Three years after launching a 750-patient Medicare Advantage collaborative care pilot, Portland, Maine-based independent physician practice NovaHealth and insurer Aetna have shown concrete results in improving care quality and reducing costs. Technology and provider-payer cooperation played a large part in the program's success.

After transitioning from tax-exempt nonprofit to a tax-paying, mutually-owned company, Michigan's largest health insurer is in pretty good financial health.

Over the past decade, states have slashed workers' compensation benefits, denying injured workers help when they need it most and shifting the costs of workplace accidents to taxpayers.

Middle age American men have been aggressively marketed treatments for low testosterone, despite risks and skepticism about benefits. Now insurers have another reason to strictly control coverage.

In the state with the highest per-capita healthcare spending, most of the mainstay insurers spent the last year struggling to harvest operating income.

One of the largest Blue Cross insurers in the American South has taken its first loss in 15 years, showing the challenges of the two main growth areas, ACA plans and Medicare Advantage.

In the guessing game and investigations of the attack on Anthem Blue Cross and Blue Shield, one early hypothesis blamed eastern European cyber mafia. Now, new evidence points further east.

Trying to recover $120 million, the nation's third largest insurer is fighting back against an alleged scheme of kickbacks, out-of-network billing and the marketing of supposedly luxurious healthcare.

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