PayerConsumer Advocates, Union, Cheer California's Health Plan Accountability Act
Civil penalties for illegal denial of coverage were increased from $2,500 to $25,000 per violation.
PayerMolina Healthcare of California Slapped with $1M Fine for Delayed Payments
Molina has also paid $80 million in disputed and delayed claims to providers, plus $1.8 million in interest.
Revenue CycleMeasuring Revenue Cycle Health Through Denials Management
An organization's denial rate is a good barometer of its overall financial health and the soundness of its revenue cycle....
PayerL.A. Care Health Plan Fined $55M For 'Deep-Rooted, Systemic Failures'
The public plan acknowledged problems with its grievance resolution process, but called the fine excessive.
Revenue CycleAvoid Paying Back $900K: Prepare Your Rev Cycle for an OIG Audit
The OIG plans to target organizations' revenue cycle in audits of severe malnutrition reporting and billing.
Payer'An Arm and a Leg': Hello? We Spend 12M Hours a Week on the Phone With Insurers
In many cases, the companies are not actually getting paid to provide insurance.
PayerMajor Insurers Running Billions of Dollars Behind on Payments to Hospitals and Doctors
Hospitals are also dealing with a spike in retroactive claims denials by UnitedHealthcare.
NursingCali AG Providers on Data Privacy, Anti-Implicit Bias Training
Stakeholders are urged to take proactive steps to protect patient data, provide perinatal staff with anti-implicit bias training.
PayerCalifornia Supreme Court will hear CMA lawsuit against Aetna
CMA claims that Aetna's actions violated the state's Unfair Competition Law.
Revenue CycleEmergency Physicians Call United Healthcare's ED Denial Policy 'Dangerous'
The American College of Emergency Physicians said that it "firmly believes that the new policy is in direct violation of...
Revenue CycleUnited Healthcare Will Deny or Limit Coverage for ED Commercial Claims it Considers Non-Emergent
The new policy will apply to "commercial fully insured ED facility claims in many states for dates of service on...
Clinical CareQ&A: Medical Necessity Documentation
One of the best defenses is a strong offense. This can be achieved by including a physician's medical necessity documentation...