Commercial Insurer Accountability
Following discussions between the American Hospital Association (AHA) and United Healthcare (UHC), the insurer late yesterday announced a refocused gastroenterology (GI) policy that relies on additional provider education rather than prior authorizations to address the insurer’s concerns about…
One in three inpatient claims submitted by providers to commercial insurers in first- quarter 2023 weren’t paid for over three months and 15% of inpatient and outpatient claims were initially denied, according to data from over 1,800 hospitals and 200,000 physicians analyzed by Crowe Revenue Cycle…
The March 21 Health & Science article “Many Americans — especially those below U.S. poverty level — are buried in hospital bills” missed a major reason that medical debt has increased in our country: the rise of high-deductible and skinny insurance plans that result in larger out-of-pocket…
TOP NEWS
The Senate Health, Education, Labor & Pensions Committee last week held a hearing aptly titled “Examining Health Care Workforce Shortages: Where Do We Go from Here?” Clearly, all of our efforts to inform policymakers and the public about the urgent need to address the workforce challenges have…
The Doximity digital platform for medical professionals has launched a beta version of ChatGPT to help streamline time-sapping administrative tasks like drafting and faxing preauthorizations and appeals letters to insurers.
AHA filed a friend-of-the-court brief urging the U.S. Court of Appeals for the 9th Circuit to affirm a federal jury’s unanimous 2022 verdict in favor of Sutter Health and certain affiliates in a lawsuit that alleged the California-based integrated health care network violated federal antitrust law…
High inflation and labor shortages, as well as sicker patients who require complex care, and low reimbursement rates combined with continued fallout from a global pandemic have created an unsustainable financial situation for hospitals and health systems around the country. Many face a devastating…
The Centers for Medicare & Medicaid Services (CMS) Dec. 12 issued a proposed rule that would implement for 2024 the standards governing health insurance issuers and the Health Insurance Marketplaces. In the rule, CMS proposes changes to the qualified health plan (QHP) network adequacy standards…
The Centers for Medicare & Medicaid Services (CMS), proposed new regulations that would streamline and reduce the burden associated with health plan prior authorization processes and improve the electronic exchange of health care information.