Revenue CycleNew Legislation Aims to Eliminate Some Prior Authorization Burdens
Establishing an electronic prior authorization process and requiring HHS to establish a process for "real-time decisions" for items and services...
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.
Revenue CycleBlue Cross Blue Shield of Massachusetts Will Incorporate Equity Measures into Payment Models
It's the first health plan in Massachusetts to announce such a plan, which will start in 2023.
PayerCDHPs Remain Popular But Waning as Sole Option, Says Large Employer Survey
"The consumer behavior aspect is a bit unrealized," says one group executive.
Revenue CycleNo Surprises Act Provision Delayed
HHS said it would defer the good faith estimate requirement for insured patients "until rulemaking to fully implement this requirement?is...
Clinical CareUnitedHealthcare Boosts Efforts to Address Social Determinants of Health
A data analytics capability added this year helps the payer target health plan members for social needs support.
FinanceCMS Prior Authorization—Operational and Financial Impact
CMS has expanded the prior authorization requirement to two new service categories within hospital outpatient department services.
Revenue Cycle4 Dos and Don'ts for Managing Inpatient-to-Observation Status Downgrades
In the newest episode of the HealthLeaders Revenue Cycle Podcast, Charlie Brown, MBA, a former hospital executive and vice president...
PayerAt Urgent Care, He Got 5 Stitches and a Big Surprise: A Plastic Surgeon's Bill for $1,040
Bryan Keller's health insurance covered much of the cost of his visit to the CityMD clinic. But it didn't cover...
Clinical CareEffort to Reform Prior Authorization Gains Traction in Texas
A new law in the Lone Star State grants automatic approval of medical orders for clinicians who have a track...
PayerSpecial Enrollment Period Spurs 2 Million People to Sign up for Health Coverage In Less Than 5 Months
CMS also reports that 2.5 million people have reduced their monthly premiums after advance payments of premium tax credits during...
PayerA 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,...