payers
publication date
Payer
At Urgent Care, He Got 5 Stitches and a Big Surprise: A Plastic Surgeon's Bill for $1,040Bryan Keller's health insurance covered much of the cost of his visit to the CityMD clinic. But it didn't cover...
Clinical Care
Effort to Reform Prior Authorization Gains Traction in TexasA new law in the Lone Star State grants automatic approval of medical orders for clinicians who have a track...
Payer
Special Enrollment Period Spurs 2 Million People to Sign up for Health Coverage In Less Than 5 MonthsCMS also reports that 2.5 million people have reduced their monthly premiums after advance payments of premium tax credits during...
Payer
A Hospital Charged $722.50 to Push Medicine Through an IV. Twice.As hospitals disaggregate charges for services, there has been a proliferation of newfangled fees to increase billing. In the field,...
Revenue Cycle
AHA Blasts UnitedHealthcare's Plan to Retroactively Deny Emergency Claims"Patients are not medical experts and should not be expected to self-diagnose during what they believe is a medical emergency,"...
Revenue Cycle
3 Ways Revenue Cycles Are Using AI Right NowYiDing Yu, MD, chief medical officer at Olive, provides an overview of how AI is successfully being used in the...
Payer
PBGH, Colorado Purchasing Alliance Announce JVThe national employer organization and the regional coalition will work to improve ?affordability and employee health outcomes" for employers in...
Revenue Cycle
United Healthcare Will Deny or Limit Coverage for ED Commercial Claims it Considers Non-EmergentThe new policy will apply to "commercial fully insured ED facility claims in many states for dates of service on...
Revenue Cycle
33% of Hospital Executives Say Their Average Denial Rates are More Than 10%The average national denials rate is between 6% and 13%, but many organizations are nearing the denials "danger zone" of...
Revenue Cycle
Expiring Waivers Could Mean Big Bills for COVID-19 PatientsWithout payer cost-sharing waivers, people with job-related or self-purchased insurance could face bills of about $3,800 for a COVID-19 hospitalization.
Payer
OIG: Medicare Advantage Overpaid Anthem $3.5MAnthem disputed the findings and rejected the recommendations in its rebuttal of the report.
Clinical Care
Allina Health, Aetna Working Collaboratively in Joint VentureAllina Health and Aetna still negotiate reimbursement for the health system's services but they bargain as amicable partners.