health insurance
publication date
Revenue Cycle
Perspective: Denials of Health Insurance Claims Are Rising — And Getting Weirder
Denials have become another predictable, miserable part of the patient experience.
Payer
Buprenorphine Battles Reveal Mixed Results
Pushback on DEA regulations is measured by medication coverage trends that are improving but still lag in many areas.
Revenue Cycle
GI Docs Rail Against UHC's Looming Prior Authorization Mandate
GI docs say the payer is using AI to move large volumes of services through prior authorization.
Payer
In the 'Wild West' of Outpatient Vascular Care, Doctors Can Reap Huge Payments as Patients Risk Life and Limb
CMS data suggests that from 2017 to 2021 90 physicians billed for more than a third of all procedures and...
Payer
Financial Burden of Dual-Eligible Beneficiaries Split Evenly on Medicare, Medicaid
Research into utilization and spending for need-based subgroups suggests integration of the two programs could better serve enrollees.
Payer
Some Employers Unsure if They Will Cover Preventive Care
Employers may follow a ruling by a federal judge that struck down preventive care services in the Affordable Care Act...
Payer
Medicare Advantage Premiums Rising as Enrollees Opt for Lower Out-of-Pocket Costs
The popularity of zero-dollar premium plans in Medicare Advantage (MA) is on the decline.
Pharma
AHIP, PhRMA Swap Blame for High Healthcare Costs
The nation's big drug and health insurance lobbies are blaming each other for rising healthcare costs.
Clinical Care
Medical Liability Insurance Premiums Increase for Fourth Straight Year
Research by the American Medical Association (AMA) finds 15 states reported double-digit percentage increases in premiums in 2022.
Payer
Providers and Insurers React to 'Deeply Flawed' ACA Ruling on Preventive Care
The new ruling applies to task force recommendations issued on or after the Affordable Care Act (ACA) was signed into...
Revenue Cycle
How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them
Internal documents and former company executives reveal how Cigna doctors reject patients' claims without opening their files. "We literally click...
Payer
AHA: Site-neutral Payments Ignore Hospitals' Adverse Patient Mix
Payers counter that removing exemptions for all site-neutral payments could save taxpayers $471 billion over 10 years.