UnitedHealth Group (UHG) is facing a class action lawsuit initiated by two families of deceased Medicare Advantage policyholders who say that the insurer's use of proprietary AI software developed by UGH subsidiary NaviHealth, denied coverage for post-acute care and left them with an untenable bill.
The family members filed suit in...
On Monday, the Centers for Medicare and Medicaid Services (CMS) proposed a new rule that would impose tighter regulations on Medicare Advantage insurers. The rule covers some hotly debated issues including prior authorization, supplemental benefits and marketing.
President Joe Biden announced last year that his administration would...
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...
Last week, the Senate Finance Committee held a hearing on the topic of "cracking down on deceptive practices" related to the advertisement of Medicare Advantage (MA) plans.
The hearing covered a long list of issues with third-party marketers who represent MA plans, including allegations of false information, harassment, switching...Arizona News
As regulators make efforts to rein in prior authorization delays and denials by private insurers and Medicare Advantage (MA) plans, Medicare and Medicaid managed care organizations (MCOs) are also garnering scrutiny over denials and network adequacy.
A new consumer survey from Kaiser Family Foundation (KFF) found that roughly 60% of...Arizona News
Arizona's top MA insurer's two-phased approach is expected to eliminate the prior authorization requirement for many procedure codes, equaling nearly 20% of UnitedHealthcare’s overall prior authorization (PA) volume.
Starting September 1, some vein procedures, durable medical equipment, breast reconstruction, radiology,...
On Tuesday, the Biden administration announced a series of proposed rules that aim to address the ongoing mental health crisis in the U.S.
The rules would require insurers to keep records and study patient mental health access and mental health benefits in order to meet the requirements outlined by the Mental Health Parity and...
More than 300 members of Congress sent a letter to the Biden administration asking it to use its regulatory authority to reduce the ability for insurers to use administrative hurdles like prior authorization to inhibit patient access to care.
The letter was signed by a bipartisan group of 61 senators and 233 members of the House of...White Papers, E books, Reports and more
The Medical Group Management Association (MGMA) published a report last week on the issues brought about by Medicare Advantage (MA) plans' use of prior authorization.
MGMA surveyed 600 medical groups on the use of PA and found that it contributes to increased costs and delays or denials of care. Groups overwhelmingly reported that...CMS Rules
Last week, the Centers for Medicare and Medicaid Services released a final rule taking aim at prior authorization and its use in Medicare Advantage. The rule also makes changes to the star ratings program and marketing reforms.
The rule stipulates that once a health plan grants prior authorization for a service, the approval will...National News
As the Centers for Medicare & Medicaid Services (CMS) mulls making changes to prior authorization (PA) across several insurance markets, America's largest insurers are automating and speeding up the process by eliminating PA requirements for select hospitals, providers and procedures and by simplifying and automating the PA...National News
Almost half of the physicians surveyed (46%) reported prior authorization policies led to urgent or emergency care for patients.
According to the American Medical Association's most recent physician survey, more than four in five clinicians (86%) reported that prior authorization requirements led to higher overall utilization of...
In the Arizona Legislature this week, the Senate Health and Human Services Committee passed a slew of health-related bills and the community weighs in on some bills that could directly impact health care providers.
The Senate Health and Human Services Committee had a busy docket this week, with six bills under close watch by the...
Last week, LeadingAge published a white paper that describes the difficulties Medicare Advantage members face accessing payment for post-acute care services.
The white paper, "Fulfilling the Promise: Medicare Advantage," identifies the issues that many beneficiaries face when attempting to access benefits, such as delays, unnecessary...
In December, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule that would require all health plans, including Medicare Advantage plans, to limit prior authorization deliberations to seven days. On Monday, the public comment for that rule closed.
Many providers believed that the rule doesn't go far enough,...
Employers are increasingly moving retirement plans to Medicare Advantage health coverage, but the retirees in question are often upset with these moves.
The City of New York recently attempted such a pivot, which led to a high-profile fight in the courtroom and public politics. Perhaps most surprisingly, the City and some unions...
While regulators, insurers and administrators make progress on rectifying the issues of prior authorization (PA), new data shows that a record number of prior authorization requests were made to Medicare Advantage (MA) insurers in 2021.
Beneficiaries enrolled in traditional Medicare are rarely subject to prior authorization, but...
Last Wednesday, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would continue the reforms around prior authorization and marketing practices for Medicare Advantage and Part D plans. The new rule is another step in the Biden administration's efforts to crack down on the Medicare Advantage marketplace's...
The Centers for Medicare and Medicaid Services (CMS) published a proposed rule which would require Medicare Advantage, Medicaid managed care organizations, Affordable Care Act (ACA) plans, and state Medicaid agencies to implement electronic prior authorization systems by 2026.
The proposed rule updates requirements for certain payers...Arizona News
A new report demonstrates that states are having a challenging time implementing and enforcing the Mental Health Parity and Addiction Equity Act (MHPAEA); Arizona is high on the list of struggling states.
The report from the Robert Wood Johnson Foundation looked at the ways in which federal state regulators address both quantitative...
