States have increasingly outsourced the provision of Medicaid services to private managed care plans. To ensure that plans maintain access to care, many states set network adequacy standards that ...

Revenue cycle management performance has never been more important. And recent advances in technology, particularly artificial intelligence, offer much potential for healthcare's administrative ...

Recently, the Department of Health and Human Services (“HHS”), Office of the Inspector General (“OIG”), HHS’s Centers for Medicare & Medicaid Services (“CMS”), and Congress have focused attention on ...

Gov. Ned Lamont's administration put forth proposals designing to lower the cost of health care in 2022. Some succeeded, while others failed. Credit: MARK PAZNIOKAS / CT MIRROR CT Mirror’s independent ...

Molly Dean, MSW, policy advisor at Siftwell, discusses how states have encouraged managed care entities to invest in local communities, build partnerships with nonprofits, and support social ...

With the announcement of the nursing home minimum staffing rule, I asked myself the same question as operators nationwide: how on earth are we going to pay for this? Even if nursing homes could find ...

There’s a key question more providers need to know the answer to: What is a contract exclusion? A contract exclusion details the medications and treatments that are not included in the levels of a ...

Historically, the US health care system has failed to effectively assess or address food insecurity and poor nutrition. However, new policy pathways are emerging to support access to interventions ...

North Carolina Medicaid managed care has finally been extended to Medicaid enrollees who also need services for behavioral health or intellectual or developmental disabilities. More than 210,000 ...

Let’s not kid ourselves. Becoming a physician today requires more than altruism. It requires courage. Thanks to the shift from fee-for-service care to third-party ...