News
New No Surprises Act rules won't fix $51 M crisis, TX group says
2+ hour, 16+ min ago (1513+ words) Christian Delbert - stock. adobe. Days before CMS announced sweeping reforms to the federal Independent Dispute Resolution process, Radiology Associates of North Texas issued a stark warning: the broken system could cost them $51 million in arbitration fees alone. For Dave Walker,…...
CMS proposes new cap on supplemental Medicaid payments
2+ week, 4+ day ago (639+ words) Christian Delbert - stock. adobe. The Trump administration is taking another step to root out fraud, waste and abuse in the Medicaid program by introducing a new cap on some provider reimbursements. In a proposed rule released yesterday, CMS floated a…...
Private payer rates outpaced Medicare's by 47%: KFF
2+ week, 5+ day ago (810+ words) Andrey Popov/istock via Getty Ima What private payers paid for hospital care has grown substantially faster than Medicare's rates for the same services over the last couple of years, according to new KFF data. KFF recently analyzed hospital prices…...
With patient collections at 31%, is AI providers' new strategy?
3+ week, 5+ day ago (1051+ words) Viorika/istock via Getty Images As out-of-pocket costs and high-deductible health plans continue to rise, health systems are finding that their legacy patient collection strategies are failing to catch up. Systems are collecting an average of just 31% of total patient…...
AMA, providers seek stricter enforcement of No Surprises Act
3+ week, 6+ day ago (668+ words) Andrey Popov/istock via Getty Ima Healthcare providers are asking lawmakers to put more pressure on payers to comply with the No Surprises Act. Payers aren't abiding by the law's payment requirements when providers prevail in the independent dispute resolution,…...
California hospitals sue Elevance over out-of-network penalty
1+ mon, 2+ day ago (535+ words) Christian Delbert - stock. adobe. The California Hospital Association has taken legal action against a recent policy from Elevance Health that penalizes provider organizations for using out-of-network physicians for non-emergency care. CHA announced on Tuesday that it filed a lawsuit against…...
United promises another 30% cut to prior auths in 2026
1+ mon, 3+ day ago (843+ words) United Healthcare is keeping the momentum rolling with prior authorization reform, promising even more reductions by year's end. United announced today that it plans to reduce prior authorizations by another 30% in 2026. The payer was also part of a group of…...
OIG: CMS paid millions in improper virtual care payments
1+ mon, 1+ week ago (316+ words) Baurzhan Ibrashev/istock via Get CMS made inappropriate payments, totaling $2. 2 million, for virtual care services between 2019 and 2022, according to a new audit report by the HHS Office of Inspector General. For the audit, the OIG assessed CMS payments for virtual…...
AMA alerts officials of health plans' No Surprises Act abuse
1+ mon, 1+ week ago (527+ words) Provider groups are adding fuel to the No Surprises Act fire, alerting administration officials to health plans that are undermining the law protecting patients from surprise medical bills. The American Medical Association (AMA), along with 111 specialty societies and state medical…...
Payers promise standardized electronic prior auths
1+ mon, 1+ week ago (502+ words) elenabs/istock via Getty Images Healthcare payers are serious about prior authorization reform, with leading health plans now promising to adopt a standardized electronic request process for most medical services. America's Health Insurance Plans (AHIP) announced on Friday that major…...