The fiscal year 2024 ICD-10-CM codes are now effective, and they will impact your reimbursement.
Earlier this year, CMS announced the addition of 395 new diagnosis codes, 25 deletions to the diagnosis code set, and 13 revisions—all of these updates were implemented October 1.
An ample amount of the code changes pertain to reporting certain diseases, accidents and injuries, and social determinants of health (SDOH).
This 2024 diagnosis code update comes at a time when hospitals and health systems are working more diligently than ever to address their patients’ social needs and the broader SDOH in the communities they serve.
When it comes to updates to SDOH, there are 30 new diagnosis codes for factors influencing health status and contact with health services. There are also a host of new guidelines for reporting these codes.
For example, there is a new code for reporting an encounter for HIV pre-exposure prophylaxis. A “code also” note instructs coders to report risk factors for HIV, when applicable.
An extensive “code also” update for “other specified problems related to upbringing” says codes for the following diagnoses should also be reported when applicable:
Absence of a family member
Disappearance and death of family member
Disruption of family by separation and divorce
Other specified problems related to primary support group
Other stressful life events affecting family and household
Robust data related to patients’ social needs is critical to hospitals’ efforts to improve the health of their patients and communities. One way to capture data on the social needs of patient populations is through proper documentation and keeping revenue cycle staff up to date on code changes, which will help to better identify non-medical factors that may influence a patient’s health status.
The other new diagnosis codes are spread throughout the code set, with several dozen pertaining to osteoporosis with fractures, retinopathy and muscle entrapment in the eye, and disease of the nervous system—including Parkinson’s disease and epilepsy.
Of the 395 new codes, 123 of them reside in the external causes of morbidity chapter of the ICD-10-CM manual, specifically new codes to capture accidents and injuries.
From prior authorizations to coding, regulatory news ranked high in popularity for revenue cycle leaders this summer.
This summer was a busy one for revenue cycle leaders as new regulations dropped, lawsuits were filed, and providers continued to fight prior authorization provisions.
Take a look at the stories that mattered most to our revenue cycle leaders this summer.
CMS recently announced the addition of 395 new diagnosis codes, 25 deletions to the diagnosis code set, and 13 revisions. An ample amount of these changes pertains to reporting certain diseases, accidents and injuries, and social determinants of health (SDOH). As mentioned, these code updates will take effect on October 1.
The new diagnosis codes are spread throughout the code set, with several dozen pertaining to osteoporosis with fractures, retinopathy and muscle entrapment in the eye, and disease of the nervous system—including Parkinson’s disease and epilepsy.
The American Hospital Association, the American Medical Association, the Blue Cross Blue Shield Association, and AHIP came together to urge CMS to not proceed with implementing proposed prior authorization standards that the organizations stated would be costly and conflicting.
In a letter penned to the federal agency, the groups argued that the provisions of the December 2022 Notice of Proposed Rule Making would be detrimental "due to conflicting regulatory proposals that would set the stage for multiple PA electronic standards and workflows and create the very same costly burdens that administrative simplification seeks to alleviate."
Cigna is on the wrong end of a class action lawsuit that alleges the payer improperly denied members' claims through an algorithm.
The lawsuit was filed in the Eastern District of California by two Cigna members who claim they were both denied payment due to Cigna's PXDX algorithm—one plaintiff was rejected for an ultrasound and the other was denied for a vitamin D test.
According to the lawsuit, PXDX allows doctors to automatically reject payments "in batches of hundreds or thousands at a time," enabling Cigna to bypass the legally-required individual physician review process.
CMS says it collects quality data from hospitals paid under the IPPS with the goal of driving quality improvement through measurement and transparency to help consumers make more informed decisions, however gathering this information for CMS is proving time consuming and expensive for hospitals.
The study published in JAMA set out to evaluate externally reported inpatient quality metrics for adult patients and estimate the cost of data collection and reporting, independent of quality-improvement efforts, and the conclusion was staggering.
A new report underscores the significant financial burden that denials pose for organizations.
Revenue cycle leaders need to address denials management and embrace tech solutions, and they should have done so a long time ago as the financial implications of denials is huge.
According to a recent study, with more than 40% of surveyed providers losing over half a million dollars annually due to claim denials, and 18% losing more than a million dollars, the financial impact is substantial, the 2023 Plutus Health Revenue Cycle Management Challenges Index says.
For these reasons and more, 43 percent of respondents to the survey said denials management is among their top priorities this year.
Denials management wasn’t alone however, as healthcare organizations said other revenue cycle priorities this year include specific payer challenges, staffing, patient eligibility and benefits verification, prior authorization, claim submission, and patient collections.
The key insight here is that revenue cycle leaders must recognize the urgency of integrating and streamlining technology to bolster their processes. By doing so, revenue cycle leaders can enhance efficiency in filing claims, reduce errors, accelerate cash flow, gain access to valuable business analytics, and ultimately provide better patient care.
Here are a few other key takeaways from the report:
Claim denials are a costing organizations big time.
The report highlights that claim denials are still a top financial burden for healthcare providers. As mentioned, more than 40% of respondents reported annual revenue losses exceeding half a million dollars due to denied insurance claims, with 18% losing over a million dollars annually.
Embracing technology is a must, but it’s not always happening.
While technology has demonstrated its effectiveness in improving revenue cycle management processes, the survey indicates that many healthcare providers remain hesitant to adopt AI and RPA. The report emphasizes the urgent need for the organizations to embrace these technologies and says that those who have integrated AI and RPA report benefits such as improved efficiency, reduced errors, faster cash flow, and better access to business analytics, highlighting the tangible advantages of adopting these solutions.
Payers and staffing are still ranking high on the revenue cycle leader’s list of challenges.
Coming in closely behind denials management, 44% of respondents cited “specific payer challenges” as a top concern, and 41% said managing staffing needs is still a major issue. This suggests that healthcare providers should not only invest in technology but also address workforce shortages and consider a combination of internal and external support to optimize their payer relations.
From coding to case management, revenue cycle tech projects are full speed ahead all throughout the revenue cycle spectrum.
Technology implementation is not new to revenue cycle, and leaders need to think outside of the traditional revenue cycle box when it comes to new technology.
Revenue cycle isn’t just patient access and billing, it spans across the clinical space too. Saving big in revenue cycle doesn’t just mean shoring up your patient-facing processes, revenue cycle leaders need to be looking in the clinical space too.
Here are three organizations who are placing a focus on middle revenue cycle technology.
The organization:
Henry Ford Health
The goal:
To improve efficiency in its coding workflows, resulting in lower costs, reduced backlogs, and enhance patient and provider experiences.
The background:
Henry Ford Health expanded its collaboration with CodaMetrix to include patient bedside visits, where abstraction takes an average of 40 minutes per patient and accounts for 20% of the health system's overall coding costs.
AI improves Henry Ford’s bedside medical coding process in several ways. First, it automatically codes the simplest procedures, taking that work off its coders’ plates. By 'simplest,' they mean the procedure notes that match closely or exactly with how the ICD codes themselves are written.
The technology does this by bringing together all the complex information required to identify, understand, and code a bedside professional charge. It then predicts and assigns charges and diagnosis codes, automating cases directly to billing.
The platform also creates a nuanced understanding of the patient journey and can identify potential charge gaps where services were likely provided but there is no documentation. Once identified and routed to coders for follow up with providers, these estimated charge gaps can equal as much as 8% of overall bedside revenue that was previously left unbilled.
By implementing the AI, Henry Ford predicts it will increase workflow efficiency by reducing errors, missed charges, billing backlogs, and claim denials while lowering costs.
The organization:
Hillcrest HealthCare System
The goal:
To create a new care model through technology that encompassed five ‘rights:’ The right patient, care, setting, documentation, and billing/payment. Using this approach, patients would be placed at the center of the conversation, with communication and care facilitated by a resource manager following that person throughout their encounter and beyond.
The background:
Hillcrest HealthCare System, the Oklahoma market of Ardent Health Services, needed to move away from siloed utilization review, care coordination, and discharge planning functions that sat side-by-side.
Hillcrest is very large in scale, so to set up a model where patients come first and processes are designed to serve them best, it needed the right technology.
Historically, it’s been a challenge for Hillcrest to introduce technology that would enable this process at the level needed. The labor required was always too great, the quantity of data needed was too vast, and consistency and leadership at scale was hard to achieve.
However, in mid-2020, it implemented XSOLIS’ CORTEX® platform to address those challenges and allow clinical staff to refocus their efforts on the patient, not administrative work. With it, the staff has access to a real-time, artificial intelligence-driven view of each patient’s medical necessity, prioritizing cases by revenue sensitivity and risk while also using the platform as a channel to communicate with payers.
In the first two years, Hillcrest’s inpatient-only alerts caught $1.76 million in potential missed inpatient revenue. Along with a 12% reduction in observation rates, this has resulted in an additional $3.28 million in inpatient revenue.
The healthcare system was also able to improve observation-to-inpatient conversion rates from 27% to 52% while reducing inpatient-to-observation downgrade rates to about 4%, a 50% sustained reduction. Inpatient denials were reduced by 102.34% in the first year.
The organization:
University of Iowa Hospitals and Clinics
The goal:
To use a “data-driven surgery” program to examine how surgical procedures are conducted, how devices and supplies are used, and where surgical team members are placed. Administrators could then look for more efficient workflow adjustments that might save time or reduce wasteful processes or the use of supplies.
The background:
University of Iowa Hospitals and Clinics (UIH) launched its data-driven surgery program in July 2021 in a partnership with Caresyntax, one of several digital health companies developing technology platforms to improve operational and clinical efficiency in different parts of the hospital. The hardware and software program taps into connected devices and platforms throughout the OR while capturing audio and video recordings of the procedure.
Using that data, UIH administrators can gain a better understanding of how surgical procedures are done, as well as how the different members of the surgical team work individually and as a team.
By leveraging EHR data review teams can also take into account clinical outcomes.
The health system has used this technology to make some short-term improvements in OR procedures, mainly affecting efficiency and room turnover rates. UIH says having 5-10 minutes off of a procedure can be an enormous amount of time saved when played out over 50 or more OR rooms.
UIH sees other areas of the hospital where this technology could help, such as the emergency department. The technology could also play a part in credentialling and training programs, especially as healthcare organizations move into value-based care and gain a better understanding of how clinical services affect the revenue cycle.
The recent UAW strike draws on similar workforce concerns revenue cycle leaders have been facing with their staff for years: technology advancement.
While the recent United Auto Workers’ (UAW) strike is historic for many reasons, the union’s asks aren’t a far cry from the demands of the healthcare workforce.
One demand by the UAW, though, parallels an issue revenue cycle leaders have been facing with their workforce for years: wanting to know where they stand in the wake of technology advancement.
For context, the UAW is voicing its concern—along with better employment benefits and wage increases—over job security related to an increase in electric-powered vehicles that require fewer parts and fewer laborers. They want to make sure their jobs remain secure as technology advances. Who else is thinking the same? Your revenue cycle staff.
We know that healthcare organizations are embracing revenue cycle automation and AI at a fast pace, with executives seeing technology as a means of improving the quality and accuracy of tasks, reducing manual labor, and improving clinical and staff workflows.
In fact, automation in the revenue cycle isn’t an if, it’s a when, and each time you implement new technology in the department, it’s not improbable that your revenue cycle staff is questioning their viability.
While the concerns of your revenue cycle staff might differ slightly from the situation faced by the UAW, at a time when workforce retention is top of mind and nearly half of healthcare workers fear that AI could take their jobs, hospital leaders need to pay attention to these massive industry strikes.
Luckily, there are a few valuable lessons that hospital leaders can draw from in this labor dispute to protect their teams from the fears of job insecurity as automation and AI continues to take hold of the revenue cycle.
Create open and transparent communication
Leaders need to maintain open lines of communication with revenue cycle staff and address concerns about technology and AI encroaching in on their department. Be transparent about the organization's plans and reassure staff that technology is meant to complement their work, not replace it.
Invest in staff training
Demonstrate your commitment to employee growth by investing in continuous training and upskilling. Show that the organization values its employees' development and is willing to adapt to changing technology together.
In fact, advancing employees’ skills should be viewed through the lens of your business objectives. As upskilling and reskilling are increasingly part of the workplace conversation, business leaders need to approach these programs as far more than short-term soultions for staff.
Emphasize job security
Make it clear that while technology may change job roles, it doesn't necessarily mean a loss of jobs. Emphasize the importance of human judgment, empathy, and critical thinking the revenue cycle—skills that are not easily replaceable by AI.
On the front and back end, patients value the human touch in these interactions, and this will continue to be a critical aspect of the revenue cycle.
And as for critical thinking, coders or clinical documentation improvement staff often use these skills to query providers and report more accurately—something AI can’t do.
Make it known AI is a tool, not a replacement
Revenue cycle leaders implement AI and technology to enhance the efficiency and accuracy of revenue cycle processes, not to necessarily replace FTEs—so make sure your staff knows that is the intention. Showcase how these technologies can reduce administrative burdens, allowing them to focus on more strategic and patient-centered tasks.
Employ collective problem-solving
Engage staff in discussions about how technology can improve their workflow and address pain points. Encourage them to provide input and be part of the decision-making process when adopting new technologies.
Provide fair compensation and benefits
While there’s a fine line between competitive salaries and financial stability, leaders should ensure that revenue cycle staff receive competitive compensation and benefits. Address any disparities or concerns related to wages and benefits promptly.
Share the long-term vision
Share the organization's long-term vision for revenue cycle technology and how staff will be integral to achieving it. Make it clear that their roles will evolve and adapt alongside technology. Leaders also need to remember that revenue cycle technology is only as good as the human staff that runs it behind the scenes.
That all being said, incorporating these strategies can help revenue cycle leaders proactively address concerns among their staff. Leaders need to ensure a more stable and collaborative work environment, which will reduce the likelihood of future workforce issues due to automation and AI advancements.
In the largest price transparency fine yet, University of Florida Health North was docked $979,000 by CMS.
UF Health North received a $979,000 price transparency fine due to several compliance violations under the No Surprises Act—a big reminder that revenue cycle leaders need to be prioritizing compliance.
According to CMS, UF Health North failed to uphold several requirements under the price transparency requirement:
Failure to update standard charge information annually: Hospitals are required to update the standard charge information annually. UF Health North failed to do so, leading to noncompliance.
Incomplete data elements in the list of standard charges: Hospitals must include all corresponding data elements in the list of standard charges, including descriptions for each item and service, payer-specific negotiated rates, and de-identified minimum negotiated charges. UF Health North did not fully adhere to these requirements, CMS says.
As the number of fined organizations is sure to grow, revenue cycle leaders need to make sure to streamline price transparency strategies.
Here are a few tasks that revenue cycle leaders need to make sure are prioritized:
Regularly update pricing information: Revenue cycle leaders should establish processes to ensure that standard charge information is updated by revenue cycle teams at least once annually, as mandated by CMS. This involves keeping track of changes in charges for services and items.
Comprehensive data inclusion: This is an area UF Health received the most dings, so leaders need to meticulous in making sure all relevant data elements in your list of standard charges is present. This includes descriptions, payer-specific negotiated rates, and deidentified minimum negotiated charges.
Implement or streamline shoppable services display: Organizations need to have a user-friendly online display of shoppable services, making it easy for patients to access and understand pricing information for common procedures.
Conduct regular compliance audits: Hospitals should conduct routine self-audits to assess their compliance with price transparency regulations. Really, audits should be in place for all compliance regulations. Also, make sure to identify and rectify any deficiencies promptly.
Educate staff: Your entire revenue cycle staff—from front end to backend—should be well-informed about the importance of price transparency compliance and trained to provide patients with accurate cost information.
Engage legal and compliance experts: The revenue cycle isn’t siloed. Continually seek the advice of the legal and compliance experts in your organization (or even outside your organization if necessary).
Stay informed: Revenue cycle leaders should be staying up-to-date with evolving regulations related to price transparency. Regulations in general are everchanging, so staying abreast of even the most mundane regulations can save you big in the long run.
Respond promptly to CMS notices: If your organization receives a notice of noncompliance from CMS, it is crucial to respond promptly and take corrective actions as required.
As denial prevention and accurate reimbursement weigh heavy on revenue cycle leaders, staying up to date on code updates minimizes these challenges greatly.
Having teams report incorrect or outdated codes can result in claim denials, delays in reimbursement, and revenue disruptions.
While coding seems like merely a middle revenue cycle task, accurate reporting also impacts financial reporting and analysis as it affects resource allocation, budgeting, and strategic planning. In this sense, incorrect reporting could potentially skew financial reports and hinder effective decision-making.
This makes knowledge of coding changes essential for everyone from the biller to the revenue cycle leader.
The most recent coding update comes from the American Medical Association (AMA) as it recently released the 2024 CPT® code set, which includes hundreds of new codes and a push for more inclusivity for certain patients.
Here are five key takeaways from the AMA’s 2024 CPT code update that revenue cycle leaders need to know.
The AMA is taking steps to improve accessibility for Spanish-speaking patients: The AMA is incorporating Spanish language descriptors for over 11,000 medical procedures and services in the 2024 CPT code set.
There are over 300 updates to the code set: The 2024 update includes 230 additions, 49 deletions, and 70 revisions.
COVID-19 immunization reporting has been streamlined: The AMA consolidated more than 50 codes related to COVID-19 immunization reporting. The consolidation of these codes and the introduction of provisional codes for specific vaccine products demonstrate are a push toward more accurate and streamlined reporting for the virus.
RSV immunization codes have been added: For organizations treating patients of all age groups, but especially children and the elderly, there are new CPT codes for reporting product-specific RSV immunizations. Accurate coding for these immunizations can aid in data-driven planning and allocation of resources as these immunizations are fairly new.
Clarifications in E/M services reporting were made: Revenue cycle leaders should be aware of the revisions made to the reporting of evaluation and management (E/M) services. These revisions aim to provide clarity and consistency in coding, including changes related to office visits, split/shared E/M visits, and hospital inpatient services.
As previously reported, there are also hundreds of changes to the diagnosis code set being implemented October 1.
Vertical relationships between physicians and health systems are increasing in the U.S. What does that mean for finance leaders?
Market disruptors are seemly everywhere for healthcare executives, and vertical integration is one of them. While CFOs know that it’s best to partner when and if you can, a new study is showing that the physician/health system “vertical relationship” may have a negative financial impact on an organization, so it’s best to plan accordingly.
A study recently published in JAMA Health Forum examined the influence of the vertical relationship between primary care physicians (PCP) and large health systems, and it has shed light on critical aspects of healthcare utilization, referral patterns, spending, and readmissions.
The study reviewed over 4 million observations of commercially insured patients in Massachusetts treated by physicians newly aligned with a health system either through ownership, joint contracting, or affiliation and compared outcomes with physicians who did not have a vertical relationship.
Vertical relationships between PCPs and large health systems were associated with a significant increase in specialist visits per patient-year, the study said. This directly impacts the utilization of specialist services and could potentially lead to higher costs associated with specialist care.
The study also demonstrated a rise in total medical expenditures per patient-year in cases where PCPs had vertical relationships with large health systems, and the increased spending on patient care could affect the financial health of your organization.
The JAMA study also found an increase in the number of emergency department visits and hospitalizations within the health system when PCPs had vertical relationships. This could place additional strain on hospital resources and require more substantial financial allocations for emergency and inpatient care.
Importantly though, the study did not identify any differences in readmission rates.
How can CFOs prepare?
Another recent study showed an uptick in physicians integrating with larger organizations with the primary driver being the need to negotiate higher payment rates with payers. Since vertical integrations and poor payer rates are seemingly here to stay, it can be in an organization’s best interest to adapt to the new financial landscape.
Here are a few ways finance leaders can prepare for physician integrations:
Understand the financial implications of these relationships: The study suggests that vertical relationships between PCPs and large health systems lead to increased healthcare spending. CFOs must be vigilant in monitoring and managing these financial aspects to ensure the hospital remains financially sustainable.
Be prepared for resource allocation: The rise in emergency department visits and hospitalizations within the health system may necessitate resource allocation adjustments. CFOs need to assess the impact on staffing, equipment, and facility requirements to accommodate increased utilization.
Take a look at the larger revenue considerations: Leaders should evaluate how these vertical relationships influence hospital revenue. An influx of patients into the health system can be beneficial if it leads to higher revenue, but it must be balanced against increased spending on patient care.
Don’t forget your payer negotiations: The strained payer/provider relationship may never ease up, so it’s beneficial for leader to understand how the impact of vertical relationships can inform negotiations with payers. CFOs and revenue cycle leaders can use this knowledge to negotiate contracts and reimbursement rates that align with the changing dynamics.
The Lompoc Valley Medical Center (LVMC) is out $5 million from a recent false claims settlement—and there are several critical takeaways for revenue cycle leaders.
Healthcare leaders continue to fight against poor operating margins, reduced reimbursement, and inflated expenses, and at a time when budgets are tight, revenue cycle leaders are under more pressure than ever to streamline processes and ensure financial stability.
The recent settlement involving LVMC in California, where the hospital agreed to pay $5 million to resolve allegations of false claims violations, provides several critical takeaways for revenue cycle leaders that can’t be overlooked as organizations are already financially strained.
What happened?
LVMC was accused of violating the False Claims Act and the California False Claims Act via a whistleblower. The allegations revolve around the submission of false claims to California's Medicaid program, Medi-Cal.
The critical components of this settlement involve LVMC's alleged involvement in submitting false claims for enhanced services provided to Medi-Cal members between January 1, 2014, and June 30, 2016.
These services were not considered allowed medical expenses as per the contract between California's Department of Health Care Services and CenCal Health, the county-organized health system responsible for arranging healthcare services for Medi-Cal patients.
Additionally, it was claimed that the payments received by LVMC did not reflect the fair market value of the enhanced services or were duplicative of services already required by LVMC. The payments were also alleged to constitute unlawful gifts of public funds, violating the California Constitution.
In the end, LVMC agreed to pay $5 million to resolve the allegations.
How can you ensure it doesn’t happen to you?
Revenue cycle leaders play a pivotal role in ensuring the financial health and compliance of their organizations, and the LVMC settlement is proof noncompliance carries significant implications for an organization.
Luckily there are several takeaways revenue cycle leaders can implement to avoid the same outcome:
Financial impact: The $5 million settlement paid by LVMC underscores the financial consequences of non-compliance with healthcare regulations. Revenue cycle leaders need to be aware that these violations can result in substantial monetary penalties, potentially jeopardizing an organization’s financial stability.
False Claims Act: Understanding the False Claims Act is essential for revenue cycle leaders and their teams as violations can lead to severe penalties. It emphasizes the need for meticulous billing practices and adherence to regulatory guidelines.
Medi-Cal and Medicaid: As we know, each payer is different, so revenue cycle teams must be well-versed in the rules governing each individual payer (and in this case Medicaid) to ensure proper billing and compliance.
Contractual agreements: The allegations in the settlement highlight the importance of hospitals adhering to contractual agreements with government agencies and payers. Leaders need to oversee (or have a team that oversees) compliance with these agreements to avoid potential legal issues.
Market valuation of services: Leaders need to assess the fair market value of services provided by their institutions. Overcharging or providing services that are not considered allowed medical expenses can lead to legal and financial repercussions.
Gifts of public funds: Understanding the legal boundaries related to the use of public funds is crucial for organizations. If not someone from the revenue cycle, then an organization’s legal team must ensure that financial transactions involving government funds comply with relevant laws and regulations.
Whistleblower provisions: The involvement of a whistleblower in this case serves as a reminder that employees within healthcare institutions may report alleged violations. Revenue cycle leaders should implement robust internal compliance programs to detect and address potential issues before they escalate.
As mentioned, this settlement serves as a significant reminder of the legal and financial risks associated with non-compliance.
By bolstering compliance protocols, reviewing contractual agreements, assessing market valuations, and investing in education and technology, revenue cycle leaders can not only avoid legal pitfalls but also help to enhance the overall financial health of their organization.
In an effort to soften the payer/provider relationship, many large health insurers are rolling back on prior authorizations.
UnitedHealthcare (UHC) is the latest to cut back on its prior authorization list.
Beginning last week, the health insurer removed hundreds of codes from its prior authorization list—mostly for genetic testing. More codes for radiology services are scheduled to be removed November 1.
Prior authorizations have long been a pain point for revenue cycle leaders, so while UHC says these removed codes account for tens of thousands of prior authorization requests a year, how much will it really help your operations?
Between the administrative time spent on submitting requests to the heap of denials they can accrue, any reduction in volume will likely speed up some revenue cycle processes—but as UHC is one payer in a large market, without a complete overhaul, this change is unlikely to make a huge dent in the overall revenue cycle prior authorization burden.
As leaders will likely still struggle with the administrative burden in 2024 and beyond, automation may be the key to lighten the workload. In fact, 39% of respondents in a recent survey said the biggest area of focus for their revenue cycle management automation in 2024 will be on prior authorization.
The decision for UHC to roll back prior authorizations comes on the heels of a substantial back-and-forth with gastrointestinal providers earlier this year.
UHC was set to require added prior authorizations for nearly half (47%) of gastrointestinal endoscopies starting June 1, saying more prior authorizations were needed to curb costs related to alleged overuse of some of these procedures by physicians.
But, after intense pushback from large medical associations, UHC pulled back.
