payers
publication date
Revenue Cycle
New Legislation Aims to Eliminate Some Prior Authorization BurdensEstablishing an electronic prior authorization process and requiring HHS to establish a process for "real-time decisions" for items and services...
Payer
Major Insurers Running Billions of Dollars Behind on Payments to Hospitals and DoctorsHospitals are also dealing with a spike in retroactive claims denials by UnitedHealthcare.
Revenue Cycle
Blue Cross Blue Shield of Massachusetts Will Incorporate Equity Measures into Payment ModelsIt's the first health plan in Massachusetts to announce such a plan, which will start in 2023.
Payer
CDHPs Remain Popular But Waning as Sole Option, Says Large Employer Survey "The consumer behavior aspect is a bit unrealized," says one group executive.
Revenue Cycle
No 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 Care
UnitedHealthcare Boosts Efforts to Address Social Determinants of HealthA data analytics capability added this year helps the payer target health plan members for social needs support.
Finance
CMS Prior Authorization—Operational and Financial ImpactCMS has expanded the prior authorization requirement to two new service categories within hospital outpatient department services.
Revenue Cycle
4 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...
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,...