Infusion centers are under growing pressure as cancer incidence rises and treatment protocols grow more complex. At the same time, staffing shortages and workforce fatigue are making it harder to meet demand. Facilities, pharmacy operations, and clinical teams aren’t scaling…
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The American Hospital Association and Federation of American Hospitals are calling on Elevance Health to rescind a new policy that would penalize hospitals for using out-of-network providers. In a Dec. 17 letter to Elevance President and CEO Gail Boudreaux, AHA…
CMS is launching its long-term enhanced accountable care organization design, or LEAD, model at the end of 2026, following the conclusion of the ACO realizing equity, access and community health model. Previously, CMS set a goal to have all traditional…
Payers and providers are locked in an “AI arms race” over coding and claims, but some industry leaders are acknowledging the battle may be a distraction from providing patient care. “The bots battling the bots is a real thing,” Sachin…
Minnesota is rehabilitating UCare, according to a Dec. 17 court filing. The state will take over the insurer’s assets and finances. While providers cannot collect payment from UCare during this time, provider contracts could be modified under the state’s supervision.…
Federal funding cuts. Clinician shortages. A projected 21% spike in the uninsured population. The conditions for a capacity crisis are already here — and most hospitals aren’t equipped to respond. But systems like Baptist Health Arkansas, University Health, Northwell Health…
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Payers have faced state penalties in 2025 for slow reimbursements, improper claims denials, and mental health parity violations. Fines in 2024 are here. Payers fined by states in 2025:
A group of 33 NorthStar anesthesia providers filed a lawsuit against Aetna and Cigna over an alleged $4.1 million in No Surprises Act underpayments, according to Dec. 8 filings in Connecticut’s U.S. District Court. NorthStar said it found claims that…
CMS will launch a voluntary pilot in 2026 to gather service-level data on prior authorization determinations and appeals in Medicare Advantage, according to a Dec. 16 memo. After the pilot, the agency expects to expand the data-collection efforts to all…
UnitedHealthcare is delaying a coverage policy that would have sharply restricted remote physiologic monitoring services for most chronic conditions. The policy, which had been scheduled to take effect Jan. 1, will now be implemented later next year, the insurer confirmed…
