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Payer Denial Tactics — How to Confront a $20 Billion Problem
The high cost to health care providers to obtain reimbursement from insurers shows no signs of abating. A recent report from the group purchasing and consulting organization Premier highlights the long-standing problem.
CY2024 Medicare Advantage Final Rule Implementation Handbook
On April 5, the Centers for Medicare & Medicaid Services (CMS) finalized its Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Program for contract year (CY) 2024. The final rule increases oversight of Medicare Advantage (MA) plans and seeks to better align MA coverage with Traditional Medicare.
CMS FAQs on 2024 Medicare Advantage Rule
In this memo, the CMS provides clarification about how MA plans should comply with the 2024 Medicare Advantage rule.
Women’s Health Startup Tia Makes an Impact Treating ‘Medical Orphans’
San Francisco-based Tia launched in 2017 with a vision of reimagining health care with women at the center and helping them to make better decisions about their health. Now, in its first “Women’s Primary Care ‘Plus’ Outcomes Report,” the company shares data about the impact the company is having on its members.
New Consumer Poll Finds Patients Are Concerned about Commercial Insurer Barriers to Care: Infographic
Commercial health insurer policies and administrative practices delay patient care, overburden clinicians and add unnecessary costs to the health care system, according to a new poll of health care consumers conducted by the Morning Consult.
Will Employees Become Fitter and Share Wearable Device Data for $1,000 a Year?
A new UnitedHealthcare Rewards program will pay eligible plan members, including spouses, up to $1,000 a year for achieving various daily health goals and one-time activities when documented through wearable devices.
Will a Chatbot Be Just What the Doctor Ordered for Reimbursement Appeals?
The Doximity digital platform for medical professionals has launched a beta version of ChatGPT to help streamline time-sapping administrative tasks like drafting and faxing preauthorizations and appeals letters to insurers.
Why Patients Leave — 4 Nonnegotiable Consumer Expectations
After surveying more than 21,000 consumers since 2017, leaders from Accenture have found some interesting answers and developed conclusions about where health care organizations should invest to improve the patient experience.
3 Looming Questions from the J.P. Morgan Health Conference
Providers, payers, data analytics companies and others working to transform health care gathered last week at the 41st annual J.P. Morgan Healthcare Conference to give updates on their strategies and progress.
Addressing Commercial Health Plan Challenges to Ensure Fair Coverage for Patients and Providers
This report documents the American Hospital Association’s (AHA) findings related specifically to prior authorization and payment delays and denials. This work is informed by two large surveys of hospitals, as well as interviews and group discussions with hundreds of hospital and health system leaders.