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Employers eye ICHRAs, but affordability remains a concern
1+ mon, 1+ week ago (532+ words) Employers are increasingly considering Individual Coverage Health Reimbursement Arrangements, or ICHRAs, for their workers' health insurance, though knowledge gaps could dampen adoption, according to a recent survey from the Employee Benefit Research Institute and Morgan Health. More than one-third of…...
Can Costco hack Medicare Advantage's consumer loyalty problems?
3+ week, 2+ day ago (945+ words) A new partnership with California-based payer SCAN Health Plan marks Costco's first step into the Medicare Advantage market, as the wholesaler unveiled new branded health insurance plans this week. The deal is scant on details so far, but SCAN did…...
Survey: Front-end workflows to blame for most claim denials
3+ week, 3+ day ago (593+ words) A recent national survey found that claims denials are a leading revenue cycle challenge for nearly three-quarters of healthcare organizations, with front-end workflows contributing the most to reimbursement breakdowns. Claim denials narrowly beat patient payment collection as the top overall…...
CMS fraud war room stops $203M in debated Medicaid payments
1+ mon, 2+ week ago (682+ words) The Centers for Medicare and Medicaid Services is already lauding a new Medicaid fraud effort to be successful in its first 90 days after identifying more than $203 million in potentially improper payments to the federal program. The Medicaid Fraud War Room…...
Physician pay cuts loom as CMS unveils major Medicare reforms
1+ mon, 4+ week ago (1084+ words) Christian Delbert - stock.adobe. The Centers for Medicare & Medicaid Services has released the proposed rule for the Medicare Physician Fee Schedule for the 2027 calendar year, which federal leaders say contains some of the most significant Medicare reforms in years. The…...
CMS locks in 2%+ payment bumps for SNFs, post-acute care providers
1+ mon, 1+ week ago (999+ words) The Centers for Medicare and Medicaid Services has finalized its payment updates to key post-acute care providers and inpatient psychiatric facilities. Skilled nursing facilities, inpatient rehabilitation facilities, hospices and IPFs all received a Medicare payment bump to their respective prospective…...
Medical supply companies banned in $3.4B fraud takedown
4+ day, 4+ hour ago (393+ words) The CMS has banned 11 medical supply companies from billing Medicare Advantage and Part D, including four that had already been barred from Traditional Medicare, after identifying more than $3.4 billion in alleged fraudulent billing practices over the last two years. The…...
How employers are rethinking benefits as healthcare costs soar
2+ week, 4+ day ago (806+ words) The data is clear: Employers are facing nearly double-digit healthcare cost growth next year. This new reality is prompting them to rethink their benefits strategies and partnerships, according to a survey by the Business Group on Health. The nonprofit organization…...
Payers say AI doesn't deny care. The truth is more complex.
2+ week, 5+ day ago (1197+ words) ipopba/istock via Getty Images Artificial intelligence does not determine whether care is approved or denied, UnitedHealth Group's Chief Financial Officer Wayne DeVeydt told reporters at the company's second quarter earnings call in July. This is a sentiment echoed by…...
AdaptHealth says hackers exfiltrated patient data in social engineering attack
2+ mon, 4+ day ago (254+ words) Vitalii Gulenok/istock via Getty AdaptHealth, a nationwide supplier of home medical equipment, disclosed a data breach that impacted an undetermined number of patients, according to a Form 8-K filing with the U.S. Securities and Exchange Commission. The company partners with…...