The initiative is likely to reduce the claim costs of insurance companies as it will help reduce fraud and provide seamless medical assistance to customers, insurance officials said. The General Insurance Council on Wednesday launched the ‘Cashless Everywhere’ initiative aimed at making cashless treatment available for policyholders even in non-empanelled hospitals registered under the Clinical Establishment Act. “Apart from being a great customer convenience and experience-centric initiative, this will also aid in better cost management.
This news comes days after the president of the hospital stepped down amid Steward Health Care’s financial crisis. “After hearing that certain surgical equipment may not be available, we made the decision to reschedule upcoming orthopedic and GI procedures at Holy Family Hospital,” said Tom Sequist, Chief Medical Officer for Mass General Brigham. “We have contacted impacted patients, and we are working to reschedule their procedures as soon as possible at a nearby Mass General Brigham or community hospital location.”
Asante Health System and one of its physicians, have agreed to pay $430,000 to settle allegations that the company and its physician knowingly submitted false claims for payment. The United States contends that, between January 1, 2015, and January 31, 2021, Asante and Dr. Charles Carmeci, a cardiothoracic surgeon practicing at Asante Rogue Regional Medical Center, knowingly submitted claims for payment to Medicare, Medicaid, and TRICARE for cardiothoracic surgeries including decortications, PleurX catheter placements, pericardiectomies, mediastinal mass resections, patent foramen ovale, atrial septal defect closures, and Bentall procedures, knowing they did not meet the criteria for reimbursement or were otherwise improper.
Baptist, the state’s largest healthcare provider, says it and other hospital groups have faced “unprecedented” costs since the pandemic, but has seen stingy reimbursement deals from insurers. The insurers, in turn, say that they can no longer pass along ever-higher health costs to employers and policyholders.
MedPAC members voted to recommend a 1.3% increase to the scheduled Medicare rates for doctors and other providers. Advisers also recommended that clinicians get extra payments for services provided to low-income Medicare patients in 2025.
The cumbersome prior authorization process has become a first-class challenge for patients and my fellow physicians. According to a survey by the American Medical Association, 94% of physicians reported delays in care due to the prior authorization process, with 33% saying the prior authorization process has been the root cause of serious adverse effects on patients.