News
Major payers say they cut prior authorizations by 11%
3+ hour, 5+ min ago (808+ words) Leading healthcare payers said they have pared back prior authorizations after taking a pledge last year to simplify the notoriously cumbersome process. America's Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association (BCBSA) reported yesterday that participating payers…...
Insurers get a 2.48% MA pay bump after close call with a flat rate
1+ day, 16+ hour ago (662+ words) Plans participating in Medicare Advantage will get a larger payment increase than originally planned, according to the finalized 2027 Rate Announcement. Yesterday, CMS released the rate announcement for Medicare Advantage (MA) capitation rates and Parts C and D payment policies for…...
CMS proposes Medicare payment rules for SNFs, 3 others
2+ day, 1+ hour ago (1050+ words) Christian Delbert - stock.adobe. CMS has proposed Medicare payment updates for four types of provider organizations, including skilled nursing facilities. On April 2, the federal agency released four proposed payment rules for skilled nursing facilities (SNFs), hospices, inpatient rehabilitation facilities (IRFs)…...
The U.S. finally bent the healthcare cost curve, one economist says
1+ week, 1+ day ago (1139+ words) National healthcare spending grew to a whopping $5.3 trillion in 2024, according to the latest numbers from CMS actuaries. But the picture isn't as bad as originally painted. That's the sentiment from a new paper from American economist David Cutler, the Otto…...
As financial standing improves, physicians worry about sustaining it
1+ mon, 3+ day ago (608+ words) Today, most physicians feel financially stable. However, they are all too aware of just how fragile that security is. Fielded by The Harris Poll, athenahealth's fifth annual Physician Sentiment Survey polled over 1,000 primary care and specialist physicians. The survey revealed…...
Report: Medicare Advantage growth gives way to SNPs
1+ mon, 1+ week ago (593+ words) Christian Delbert - stock.adobe. Medicare Advantage enrollment growth is continuing its downward trend, with new Chartis numbers showing enrollment grew only 2.5% this year, compared to the 3.6% seen in 2025 and the historic 7% growth in the early 2020s. All said, Medicare Advantage enrollment…...
New report shows NSA is working. So, why are payers, providers still mad?
1+ mon, 1+ week ago (640+ words) A recent report published by the Government Accountability Office (GAO) indicated greater provider participation in health plan networks following implementation of the No Surprises Act (NSA), suggesting fewer surprise medical bills for patients. In 2022, the NSA generally prohibited surprise medical…...
Employee health plan costs eat up 10% of wages
1+ mon, 3+ week ago (757+ words) The average American family spends 10.1% of their paycheck on their employer-sponsored health insurance premiums and deductibles, according to new Commonwealth Fund data, illustrating a healthcare affordability crisis that's increasingly affecting the middle class. "Premiums and deductibles for many American workers…...
Nearly half of TrumpRx drugs have generic options available
2+ mon, 1+ day ago (351+ words) Ca-ssis/istock via Getty Images TrumpRx went live on Thursday, following a delay in its highly anticipated launch the week before. But many of the drugs offered on the long-promised pricing portal already have generics available on the U.S. market or…...
Nearly 45% of healthcare payments tied to APMs: Survey
2+ mon, 4+ day ago (503+ words) AndreyPopov/istock via Getty Ima Health plans remain committed to value-based care, with both public and private payers funneling dollars to alternative payment models, according to a new survey from America's Health Insurance Plans. This year, AHIP continued the partnership…...