Payer: Page 51
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Surprise Billing1 in 5 Americans report still receiving surprise medical bills after federal ban
A Morning Consult survey highlights weakness in the surprise billing law, which does not protect consumers from balance bills related to labs and blood work in all instances.
By Samantha Liss • July 11, 2022 -
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CMS proposed payment rule includes major updates for ACOs
Changes to the Medicare Shared Savings Program would give some accountable care organizations more time to ramp up to performance-based risk and updated quality reporting.
By Shannon Muchmore • July 8, 2022 -
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CMS finds 'troubling' implicit bias in 3 payment models
CMMI has taken initial actions to address existing bias, and has started developing a guide to screen and mitigate it in various models, according to a new article in Health Affairs.
By Rebecca Pifer Parduhn • July 8, 2022 -
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'Phantom' provider lists limit Medicaid mental healthcare access, study finds
The Health Affairs research showed that inaccurate provider directories may create a barrier to treatment for a population that needs it most.
By Susan Kelly • July 6, 2022 -
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Marketplace insurers denied 18% of in-network claims in 2020, data shows
Five years into ACA-mandated transparency for coverage data, reporting for 2020 remained spotty, showing limited insight into coverage denials.
By Sydney Halleman • July 6, 2022 -
Social needs program for Medicaid beneficiaries can be effective but costly, research finds
The youngest patients enrolled in the program saw the greatest reduction in healthcare use while less of an impact was seen among older patients. Also, 60% of patients enrolled in the program did not engage.
By Hailey Mensik • July 5, 2022 -
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To aid rural hospitals, CMS proposes rule for new provider type
The rural emergency hospital designation is expected to help prevent facility closures and maintain access to crucial healthcare services.
By Susan Kelly • July 5, 2022 -
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CMS wants Tennessee to change Trump-approved Medicaid block grant plan
Regulators sent a letter to Tennessee requesting the state submit a new financing and budget neutrality model based on a traditional per member per month cap, instead of an aggregate cap, among other changes.
By Rebecca Pifer Parduhn • July 1, 2022 -
CMS insurer price transparency rule has taken effect. Signs are good for compliance
UnitedHealthcare, Anthem and Centene are among the major payers already hosting machine-readable cost files onsite.
By Rebecca Pifer Parduhn • July 1, 2022 -
Aetna rolls back prior authorization requirement for cataract surgery
The payer said its decision came after analyzing real-time data when the requirement was in place and that it will continue to perform retrospective reviews.
By Shannon Muchmore • June 30, 2022 -
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CVS long-term care unit Omnicare taps new president
Ahmed Hassan, who will assume the role Friday, will be tasked with leading CVS’ long-term care business and formulating business strategy.
By Sydney Halleman • June 30, 2022 -
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House hearing ups ante on Medicare Advantage reform
Lawmakers on both sides of the aisle are taking a harder look at coverage denials, fraud and waste in the popular program.
By Rebecca Pifer Parduhn • June 29, 2022 -
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Mass General Brigham's health plan launches rebrand as it looks to expand
AllWays Health Partners will change its name to Mass General Brigham Health Plan as it looks to leverage the name recognition of the system and deepen integration with the provider.
By Samantha Liss • June 29, 2022 -
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Democrat governors urge Congress to prevent 'disastrous' coverage loss by preserving ACA subsidies
The 14 governors said they’re concerned many Americans will be forced to reduce insurance coverage or forgo it entirely if Congress allows the subsidies to expire.
By Rebecca Pifer Parduhn • June 29, 2022 -
CMS launches voluntary incentive program aiming to cut cancer death rate
The Enhancing Oncology Model requires participating providers to offer services including patient navigation, 24-hour access to clinicians, a detailed care plan and screening for social needs.
By Susan Kelly • June 29, 2022 -
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Overturning of Roe v. WadeFollowing Roe ruling, Biden administration warns payers they must cover contraception
Historically, insurer compliance with this provision of the law has been inconsistent, but the stakes for women’s health are significantly higher given the Supreme Court’s decision on Friday.
By Rebecca Pifer Parduhn • June 28, 2022 -
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UnitedHealth's Optum looks to cut down on unnecessary lab testing
Optum says roughly 13 billion clinical lab tests are performed each year and 30% are unnecessary.
By Samantha Liss • June 27, 2022 -
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Sentara appoints new CEO
Dennis Matheis will assume his new role Sept. 1 with the nonprofit system that operates 12 acute care hospitals across Virginia and North Carolina and a health plan with over 800,000 members.
By Hailey Mensik • June 27, 2022 -
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Colorado first state to launch public option via federal waiver
Through the waiver granted by the CMS on Thursday, Colorado can use federal funds to set up a government-run health plan, a long-held progressive healthcare goal.
By Rebecca Pifer Parduhn • June 24, 2022 -
SCOTUS rejects UnitedHealth appeal of Medicare Advantage overpayment rule
The justices declined to take up the case, leaving intact a lower court ruling that backed the 2014 CMS regulation requiring swift return of overpayments.
By Susan Kelly • June 22, 2022 -
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Molina to pay $4.6M to settle False Claim Act allegations
The settlement comes after whistleblowers brought a suit against Molina and a former subsidiary, alleging care at Massachusetts-based behavioral health clinics was given by inadequately trained and unsupervised clinicians.
By Sydney Halleman • June 22, 2022 -
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Medicare data errors impede health equity efforts, OIG says
The ability to assess health disparities and improve care delivery in communities of color hinges on the quality of race and ethnicity data that is currently falling short, the report said.
By Susan Kelly • June 21, 2022 -
E.A. Crunden/Healthcare Dive
Washington ups pressure on PBMs with more aggressive FTC policy, congressional ask for GAO study
The Federal Trade Commission has voted unanimously to adopt a policy statement to more closely examine fees and rebates paid to PBMs in exchange for preferred coverage of their drugs from payers.
By Rebecca Pifer Parduhn • June 21, 2022 -
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CVS appoints new chief strategy officer
Prior to joining CVS, Violetta Ostafin was at insurance company Aon, and also worked as a managing director and partner at Boston Consulting Group.
By Rebecca Pifer Parduhn • June 17, 2022 -
Opinion
Expiration of healthcare subsidies will have domino effect, leading to higher prices and increased medical debt
Millions of Americans will experience dramatic price increases, become uninsured and likely accrue medical debt, GetInsured’s Heather Korbulic argues.
By Heather Korbulic • June 16, 2022
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