Healthcare policy and regulation
Policy and regulation significantly affect payers by dictating the standards for health plan offerings, determining coverage requirements, and influencing cost structures. These rules also guide patient data management, ensuring privacy and security, and play a crucial role in shaping overall healthcare market competition, payer strategies and healthcare spending.
Top Stories
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News
10 Feb 2026
CMS to crack down on ACA plan marketing, tighten income verifications
The proposed notice of benefit and payment parameters for 2027 would tighten marketing for ACA plans and income verification rules for consumers seeking assistance with marketplace coverage. Continue Reading
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News
28 Jan 2026
Orgs with more MA patients face more readmission penalties
Deeper Medicare Advantage penetration changes the risk pool for hospitals, leading to higher penalties in the Hospital Readmissions Reduction Program, data shows. Continue Reading
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News
03 Jul 2019
ACA Risk Adjustment Worked as Intended in 2018, CMS Reports
CMS found that the ACA risk adjustment program successfully distributed the financial risk. Continue Reading
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News
21 Jun 2019
CMS Defines New Medicaid Integrity Guidelines
CMS set new integrity guidelines and warned states of future audits on Medicaid eligibility determinations. Continue Reading
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News
07 Jun 2019
How Does the Health Payer, Insurance Industry Support the Economy?
Health payers generate economic growth by providing insurance coverage, creating jobs, and making tax contributions, according to AHIP. Continue Reading
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News
22 Apr 2019
How to Be More Efficient in HEDIS Reporting
By remediating gaps in data collection, health plans can immediately improve the efficiency of HEDIS reporting. Continue Reading
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News
13 Nov 2017
Top 5 Most Common Healthcare Provider Fraud Activities
The most common healthcare provider fraud activities drain public payer finances and promote unsafe care conditions for beneficiaries. Continue Reading
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News
20 Sep 2017
Top 10 Healthcare Spending Categories in the United States
Many of the highest healthcare pending categories in the US continued to climb as indicated by significant growth in expenditure amounts. Continue Reading
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News
15 Jun 2017
AMA, AHA Call for Stronger Patient Insurance Protections
The AMA joins other prominent health industry groups in calling on the Senate to address patient insurance protection concerns. Continue Reading
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News
18 May 2017
CMS to Shutter Small Business Health Options Program Website
CMS will close its portal allowing small business to enroll members on the health insurance exchanges due to low usage rates. Continue Reading
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Feature
04 Nov 2016
The Progress and Challenges of the Affordable Care Act
Various clauses of the Affordable Care Act brought obstacles for insurers to overcome. Continue Reading
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Answer
15 Jun 2016
How the Affordable Care Act Changed the Face of Health Insurance
Why have health insurance rates gone up after the Affordable Care Act was implemented? Continue Reading