Payers, providers applaud new CMS prior authorization rule

Provider groups, including the AHA, asked the Senate to codify measures proposed by the CMS by passing bipartisan legislation imposing more prior authorization requirements on Medicare Advantage plans.

By Rebecca Pifer Parduhn • Dec. 8, 2022

UnitedHealth’s $5.4B buy of LHC expected to close in Q1

UnitedHealth’s buy of home health provider LHC Group for $170 a share could close as early as Jan. 6.

By Rebecca Pifer Parduhn • Dec. 7, 2022

CMS proposes new prior authorization requirements for payers, including MA plans

Regulators want payers to issue coverage decisions within 72 hours for urgent prior authorization requests — but the final turnaround time could be even shorter.

By Rebecca Pifer Parduhn • Dec. 7, 2022

18M projected to lose Medicaid coverage at end of COVID-19 emergency

Many people who are currently enrolled in Medicaid will transition to other coverage, but 3.8 million people will completely lose insurance, according to the Robert Wood Johnson Foundation.

By Susan Kelly • Dec. 6, 2022

Key healthcare stories from 2022

This year has been especially tumultuous for healthcare, with the overturning of Roe v. Wade, numerous labor disputes and major M&A announcements.

By Shannon Muchmore • Dec. 5, 2022

Emerging regulatory standards are paving the way for a new era: Unified experiences will be healthcare’s future

The impending changes to prior authorization processing aren’t minor, and they aren’t the only types of regulatory transformation that healthcare organizations will need to navigate in the months and years to come.

Dec. 5, 2022

UnitedHealthcare loses lawsuit to TeamHealth — again — in ongoing battle over billing

A three-judge arbitration panel in Florida has awarded $10.8 million to TeamHealth after finding UnitedHealthcare underpaid the physician group’s clinicians from 2017 to 2020.

By Rebecca Pifer Parduhn • Dec. 2, 2022

Texas Medical Association files third lawsuit over surprise billing ban

This latest filing targets the methodology for how payments are calculated and used during arbitration.

By Samantha Liss • Dec. 1, 2022

UnitedHealth Group projects up to $360B in 2023 revenue, buoyed by Optum growth

The projected revenue growth comes after the Department of Justice announced this month it would appeal a federal judge’s decision that allowed UnitedHealth’s $13 billion purchase of Change Healthcare to close.

By Sydney Halleman • Nov. 30, 2022

Bernie Sanders poised to lead Senate health committee

The longtime proponent of universal healthcare is set to become chair of the Health, Education, Labor and Pensions Committee. Sen. Bill Cassidy, R-La., is in line to be the committee’s ranking member.

By Susan Kelly • Nov. 28, 2022

Health insurance customer experience starts at open enrollment

Why health plan consumer experience matters; from the perspective of a stressed-out son.

By Maryann Waugh, Director of Content and Research • Nov. 28, 2022

Centene continues to sell ancillary business units

The sale of Magellan Specialty Health is the latest divestiture in Centene’s plan to sell non-core assets as part of a long-term strategy to improve the company’s profit margin.  

By Samantha Liss • Nov. 23, 2022

Lawmakers object to latest surprise billing rule, call for changes

House Ways and Means Committee leaders “are severely disappointed to find that the August 2022 final rule violates the No Surprises Act in the same ways as before,” they wrote in a letter to regulators last week.

By Samantha Liss • Nov. 22, 2022

HHS to look at MA risk adjustment as upcoding in spotlight

Regulators have considered changing how they calculate patient risk and provider reimbursement, work that the HHS head said is continuing.

By Rebecca Pifer Parduhn • Nov. 17, 2022

Divided Congress after midterms will allow HHS to execute on policy priorities, Becerra says

The department will focus on implementing drug price negotiation in Medicare and surprise billing regulations, according to the secretary.

By Rebecca Pifer Parduhn • Nov. 16, 2022

Elevance plans to continue aggressive M&A, CEO says

CEO Gail Boudreaux said the insurer plans to grow "very aggressively" into adjacent care services.

By Rebecca Pifer Parduhn • Nov. 15, 2022

Maven raises $90M, fueling push into Medicaid, CMO says

Roadblocks for the startup include shifting requirements state-by-state and historically low margins in Medicaid.

By Rebecca Pifer Parduhn • Nov. 15, 2022

Medical group asks Congress to offset Medicare payment cuts

The Medical Group Management Association wants Congress to take action to help physician practices by the end of the year.

By Susan Kelly • Nov. 15, 2022

Nearly 1 in 4 gig workers lacks health insurance, survey finds

A majority of those workers cited affordability as the main barrier to getting coverage, according to a poll from insurance broker Stride Health.

By Susan Kelly • Nov. 15, 2022

Cigna’s MDLive will add chronic care program to virtual primary care plans

Initially, the program will be available for patients with hypertension, but will expand throughout the year to other common chronic conditions.

By Rebecca Pifer Parduhn • Nov. 14, 2022

Bright Health ceases MA operations in Florida in latest business cut

The newest reduction for the insurtech comes less than a month after Bright announced it was leaving the Affordable Care Act exchanges and slashing its Medicare Advantage footprint to just Florida and California.

By Rebecca Pifer Parduhn • Nov. 10, 2022

Profits continue to climb for payers as possible recession looms

Despite talk of a recession, all major insurers expect a rosier end to 2022 than previously predicted. On the other hand, profits fell for large hospital operators faced with pricier labor and lower volumes.

By Samantha Liss • Nov. 9, 2022

Elevance Health to acquire specialty pharmacy BioPlus

BioPlus will complement the payer’s existing pharmacy benefit manager, IngenioRx, providing patients with specialty drugs and a whole-health approach.

By Samantha Liss • Nov. 9, 2022

What’s in it for Evernorth? Cigna’s health services arm invests $2.5B in VillageMD-Summit

The deal could have major ramifications for Evernorth’s push to value-based care in the commercial sector, according to Cigna executives and analysts.

By Rebecca Pifer Parduhn • Nov. 9, 2022

Tomorrow’s healthcare industry leaders will be masters of agility and innovation — a product mindset will show them the way

Though healthcare hasn’t always been considered a hotbed of innovation; new market pressures are pushing payer and provider organizations to become more flexible and agile than ever before.

Nov. 7, 2022