Author's posts
Insurers may be violating No Surprises Act over Qualified Payment Amounts
In possible violation of the No Surprises Act, health insurance company calculations of Qualified Payment Amounts for anesthesiology, emergency medicine and radiology services – and possibly other specialty services – likely include rates from primary …
Medicare Advantage lacking for mental health coverage
Overall customer satisfaction with Medicare Advantage plans has increased this year, thanks largely to improvements in billing and payments, cost and provider choice. But according to the new J.D. Power 2022 U.S. Medicare Advantage Study, some concerni…
Nonprofit hospitals’ outlook downgraded to ‘deteriorating’ by Fitch
Due to labor and other macro inflationary pressures, Fitch Ratings has revised its outlook for nonprofit hospitals and health systems to “deteriorating.”
High out-of-pocket costs are negatively affecting revenue cycles
In art and photography, the “vanishing point” is the point at which two lines converge, meeting at the horizon line and suggesting three-dimensional space. In hospital revenue cycles, the vanishing point is $7,500.
Managing costs, operational efficiencies top challenges for payers
In 2021, the pace of change in the healthcare industry picked up dramatically, with the introduction of new regulatory requirements, rising expectations among consumers, new competitive threats and the shift toward value-based payment strategies. This …
UnitedHealthcare seeks to remove deductibles with Surest offering
UnitedHealthcare is making a push to remove deductibles and provide clear, upfront pricing information with its new Surest offering, itself a rebrand of Bind, which was introduced in 2016. According to UHC, Surest has the fastest growth rate among its …
Labor shortage, inflation contribute to Mass General Brigham’s $949M net loss
Significant financial pressures, including a widespread labor shortage, cost inflation and the enduring capacity crisis, have contributed to a rough financial quarter for Mass General Brigham, which saw a $949 million net loss and -2.8% operating margi…
OIG: Part D plan preference for pricey hepatitis C drugs led to higher Medicare spending
Some Medicare Part D plans left behind millions of dollars in savings because they didn’t cover generic versions of expensive hepatitis C drugs in 2019, in part due to the structure of the Part D program itself, finds a new report from the Department o…
Humana acquiring Inclusa, expanding Medicaid services in Wisconsin
Humana is set to acquire Wisconsin-based managed care organization Inclusa in an effort to expand its Medicaid presence in that state. Inclusa provides long-term care services and supports to approximately 16,600 older adults and adults with disabiliti…
BCBS Michigan debuts Maven-powered family building, maternal program
Ahead of this year’s open enrollment, Blue Cross Blue Shield of Michigan is teaming with Maven Clinic to launch a new family building and maternity support program.
It includes a personalized digital care app to help guide members through family planni…
