While Congressional Republicans continue to negotiate a package bill for President Donald Trump's second-term agenda, House Republicans have advanced a short-term funding bill to avoid a government shutdown. The bill that moved to the Senate dropped a correction to Medicare physician payment cuts that had been promised by Republican...Arizona News
In his first public remarks since the public murder of UnitedHealthcare (UHC) CEO Brian Thompson in December, UGH CEO Andrew Witty told investors during the fourth-quarter earnings call that the insurer is close to rolling out a new initiative to streamline prior authorizations.
Nearly all enrollees in Medicare Advantage are subject...
This week, the American Medical Association (AMA) published its annual Substance Use and Pain Care Task Force Overdose Epidemic Report.
The report covers the overdose epidemic, harm reduction efforts, naloxone access and mortality statistics. It also investigates industry response to the issues surrounding the epidemic and promotes...
The American Medical Association (AMA) has filed suit in the Northern District of Illinois against data analytics company/claims discounter/wrap network, Multiplan for what it claims is a price-fixing conspiracy on behalf of health insurers.
The lawsuit claims that MultiPlan benefits from lowering estimates of out-of-pocket...National Reports & Surveys
A 2023 Affordability Survey reveals significant challenges Americans face with the appeals process for claim denials and billing errors.
Patients and their families are confused about their right to appeal and who to contact, and a high rate of successful appeals suggests potential flaws in the initial determination process. Sara...National News
As legislative season advances, more than 40 states across the country are expected to consider bills that aim to speed up the delivery of care or place restrictions on the use of prior authorization by insurance plans.
In 2023, states enacted 20 bills that target prior authorization practices, but this year more than 70 measures have...Arizona News
Last Wednesday, the Centers for Medicare and Medicaid Services (CMS) finalized a rule that will truncate the timeline for prior authorization processes to 72 hours for people who receive health coverage from insurers participating in Medicare Advantage, Medicaid managed care, or the Affordable Care Act exchange.
The CMS...
As the use of artificial or augmented intelligence (AI) becomes more widespread across healthcare, industry leaders are advocating for guardrails and guidance to alleviate the risks that come with the software.
On Tuesday, the American Medical Association (AMA) released new "principles for augmented intelligence," which expounds on...
The joint commitment among the five founding members aims to leverage learned lessons from the COVID-19 pandemic response into actionable strategies that will strengthen the partnership between healthcare and public health systems.
In March 2023, the Common Health Coalition (CHC) was formed by AHIP, the American Medical Association...
On Monday, President Joe Biden signed an executive order (EO) to establish a set of standards for the use of artificial intelligence in healthcare settings.
The order asks the U.S. Department of Health and Human Services (HHS) to establish a task force that will be given a year to develop guardrail policies for the use of AI and...
Providers, payers and the government have yet to reach a consensus on how telehealth services will be compensated following the COVID-19 pandemic and the waivers that the public health emergency allowed.
During the pandemic, Congress required that insurance companies pay equally for virtual visits as it would for in-person care for...
Physicians and related stakeholder groups have rallied against the 2024 physician fee schedule proposed rule, which was issued in July. The rule is expected to be finalized shortly, but providers are saying that any cuts could jeopardize access to primary care.
The proposed rule contains a 3.36% cut to the conversion factor for...CMS Rules
The Centers for Medicare and Medicaid Services (CMS published its proposed physician fee schedule (PFS), which add up to a 1.25% decrease in pay for Medicare physicians for 2024. Physician groups and industry leaders met the news with frustration, with some doubling down on calls to reform the entire payment formula. CMS also posted the...National News
Medicare-eligible seniors face more options than ever when considering Medicare Advantage (MA) and supplemental coverage. This year, the average beneficiary has nearly 70 different MA and Medicare Part D stand-alone plan options, with a litany of supplemental benefit offerings including many related directly to primary care.
According...White Papers, E books, Reports and more
The American Medical Association (AMA) published a study last month that found a lack of "competition in local markets" among pharmacy benefit managers (PBMs).
The analysis found that over a third of national markets for formulary management and benefit design were managed in-house by insurance companies rather than purchasing middle...
The Texas Medical Association (TMA) will now lead the charge against the federal government's rules for implementing the No Surprises Act, which aims to curb surprise bills levied on patients who unknowingly or in times of emergency receive care from providers who are out-of-network for their insurance coverage.
Last week, the...
Cigna contracts with MultiPlan, the largest PPO network in the country. The insurer was accused of intentionally underpaying provider claims and increasing administrative fees in a lawsuit filed in a Connecticut federal court.
The American Medical Association joined the Medical Society of New Jersey and the Washington State Medical...
The non-profit healthcare accreditation group for more than 22,000 providers across the country, the Joint Commission, has established new accreditation standards to improve health equity within healthcare organizations. The standards will apply to hospitals, critical access hospitals, primary care providers and ambulatory surgical...
Medicare Advantage prior authorization reform has strong support as legislation passed through the U.S. House Ways and Means Committee last Wednesday with unanimous support.
Representative Suzan DelBene (D-Wash.), who introduced the Improving Seniors Timely Access to Care Act, said the committee vote sets the stage for a floor vote...
This month's mass murders in Uvalde and Buffalo have reignited a call to address firearm violence in America as a public health crisis. "Our inaction has allowed it to spread through this nation like a deadly virus. We must find the courage — and the creativity — to stop it," said the president of the National Academy of...
