Commercial Insurer Accountability
The Department of Health and Human Services Office of Inspector General yesterday issued an alert warning of marketing schemes by certain Medicare Advantage plans.
A $2.8 billion settlement from Blue Cross Blue Shield to health care providers resolving a 12-year antitrust lawsuit received preliminary approval yesterday from the U.S. District Court for the Northern District of Alabama. The settlement will also "significantly improve how Providers will interact…
Before the lame-duck session ends and the 118th Congress adjourns, it is essential that federal lawmakers understand the challenges hospitals and health systems face and what is at stake for the patients and communities they represent.
AHA letter urging Congress to act on key priorities in Lame-duck session.
The AHA Oct. 17 released its Health Care Plan Accountability Update, covering the latest developments in Medicare Advantage, legislation and regulation of private health insurers, as well as other resources from the last quarter.
CMS released a new complaint process for providers seeking assistance from the agency in resolving Medicare Advantage claims issues.
While lawmakers are in their district, it is important for the field to engage with members of Congress to remind them of the importance of preserving access to care by continuing to fund vital programs like telehealth and hospital-at-home waivers, and avoiding harmful policies such as site-neutral…
Clinical validation audits are a new tactic that certain commercial insurers are adopting to reduce or deny payment to health care providers and can take months or even years to be adjudicated and resolved.
. In this conversation, Richelle Marting, director of managed care contracting at North Kansas City Hospital, and Chris Thompson, executive director of reimbursement and compliance for managed care at AdventHealth, discuss the rapid growth in these audits, the financial strain they can put on…
There will always be administrative costs associated with operating a hospital. But the lion’s share of a hospital’s resources should be devoted to doing what hospitals do best: provide safe, accessible and exceptional patient care to anyone who needs it.