Here are four payer-related headlines in the last two weeks for ASCs to know.
1. Medical practices and hospitals saw claims denials increase and prior authorization denials decrease in 2024, according to new revenue cycle data from Kodiak Solutions. Despite the decline in prior authorization denials, medical practices and hospitals still faced slower payment processing from insurers in 2024 compared to 2023.
2. Illinois, Minnesota and California are phasing out or limiting health coverage benefits for documented and/or undocumented immigrants following expenses that were greater than anticipated.
3. UnitedHealth Group’s former CEO Andrew Witty has resigned from the company’s board of directors, effective immediately. On May 13, UnitedHealth replaced Mr. Witty with its board chair and former CEO, Stephen Hemsley. Mr. Witty had served as UnitedHealth’s CEO since 2021 and stepped down for “personal reasons.” UnitedHealth Group is under criminal investigation by the Justice Department for alleged Medicare Advantage fraud, The Wall Street Journal reported May 14. Citing individuals familiar with the matter, the outlet said the Justice Department has been investigating the company since the summer of 2024 over its MA business practices, but exact criminal allegations are unclear.
4. Payers remain divided on how to approach and manage the high cost of GLP-1 drugs. In May, CVS Health announced a partnership with Wegovy manufacturer Novo Nordisk. CVS Caremark will use Wegovy as the preferred GLP-1 medication for its largest commercial formulary. Beginning July 1, CVS Caremark will drop Zepbound, manufactured by competitor Eli Lilly, CNBC reported. The Cigna Group also announced new efforts in managing GLP-1 costs in May, taking a different approach from CVS. Cigna will add two new programs, one designed to support pharmacies dispensing the drugs, and a home-delivery program.
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