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…
AHIP’s board of directors has elected Humana President and CEO Jim Rechtin as board chair effective Jan. 1. Mr. Rechtin succeeds Pat Geraghty, who announced his retirement after leading GuideWell and Florida Blue for 14 years. AHIP also named Patrick…
Hospitals are navigating historic cost and workforce pressures, and the revenue cycle is under the microscope. More CFOs are moving from a patchwork of vendors to accountable, end-to-end partnerships to protect margin, stabilize cash and reduce operational risk. This report…
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Reimbursement is uncertain, denials are up and high-deductible health plans mean more financial risk is falling on patients. These headwinds are forcing CFOs to re-evaluate an overlooked lever: the patient financial experience. Read more about how CFOs and COOs from…
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Humana’s Louisiana business received at least $10.5 million in Medicare Advantage overpayments in 2017 and 2018, according to an audit report from HHS’ Office of Inspector General. The audit, published in December, reviewed high-risk diagnosis codes including acute stroke, acute…
Digital identity wallet service ID.me entered into a contract with CMS, with rollouts to improve secured access and user experience coming to Medicare.gov in early 2026. ID.me will act as an identity verification and sign-in option for the website. User…
