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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...including Cigna and Aetna, which have maintained that AI is never used to deny claims or care. Still, insurers...insurers continue to shovel billions of dollars…...
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…...
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…...
OIG calls on states to tamp down Medicaid provider fraud
1+ mon, 2+ week ago (652+ words) Flavijus Piliponis â stock.ado The HHS Office of Inspector General wants states to ensure stronger contractual obligations with Medicaid managed care organizations to flag Medicaid provider fraud, the agency wrote in a recent report. Specifically, OIG called for CMS…...
Appeals court overturns No Surprises Act QPA calculation method
4+ week, 2+ day ago (657+ words) In a major win for healthcare providers, a U.S. appeals court ruled against the federal government's formula for calculating qualifying payment amounts under the No Surprises Act. The ruling released on Tuesday tossed aside two key factors insurers use to determine…...
Medical supply companies banned in $3.4B fraud takedown
4+ day, 1+ 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…...
AdaptHealth says hackers exfiltrated patient data in social engineering attack
2+ mon, 4+ day ago (254+ words) Her coverage areas include cybersecurity, HIPAA compliance, interoperability, AI and EHRs....
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…...
How providers can weather Medicaid cuts when many won't
3+ week, 3+ day ago (1417+ words) Recent Medicaid and Affordable Care Act changes will have a widespread impact on healthcare providers, whether they work for large health systems or small ambulatory practices. However, some types of providers stand to lose more than others, and the effects…...
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…...