The National Committee for Quality Assurance has named the highest quality and most effective health plans of 2025 based on nearly 50 factors that include patient experience and clinical performance. The ratings were released Sept. 16 and are based on…
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From under-coded exams to misconfigured billing systems, radiology groups are losing revenue daily. One West Coast practice uncovered major losses tied to automation errors and poor queue oversight. Others miss reimbursement altogether due to basic demographic and authorization missteps. Uncover…
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Aetna’s new “level of severity inpatient payment” policy will take effect in less than two months, and the American Hospital Association said it is “deeply concerned.” Aetna’s policy, set to go into effect Nov. 15, will approve inpatient stays without…
Complex wounds don’t heal on a schedule — and traditional hospital-based care models often fall short once patients go home. In this session, Erich Lemker, MD, a board-certified plastic surgeon at Community Regional Medical Center in Fresno, Calif., shares how…
Oct 21, 2025 11:00 AM - 12:00 PM America/Chicago
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Presenters
Erich Lemker, MD
Board-Certified Plastic Surgeon, Community Regional Medical Center
Ambulatory Surgery Centers face unique revenue cycle challenges — from implant-heavy procedures to payer-specific contract rules and front-end requirements that, if missed, quickly turn into denials and revenue leakage. With leaner margins than hospitals, effective accounts receivable (AR) management isn’t…
Oct 2, 2025 12:00 PM - 1:00 PM America/Chicago
Presented by:
Presenters
Dylan DeScheda
Vice President, Accounts Receivable, nimble solutions
Tonya Bailey, VP
Payment Posting, Credits and Charge Posting, nimble solutions
Baltimore-based Johns Hopkins Medicine has ended contract negotiations with UnitedHealthcare without a new deal, The Baltimore Banner reported Sept. 15. Johns Hopkins went out of network with UnitedHealthcare on Aug. 25 after eight months of negotiations and several extensions of…
Robert Andrews — a former congressman and the CEO of the Health Transformation Alliance, a cooperative of self-insured companies — predicts AI will be able to personalize formularies for patients within five years. “Formularies are really built upon economic, commercial…
The California Department of Managed Health Care has issued a cease-and-desist order against Meritage Health Plan, effectively shutting down the Medicare Advantage insurer by the end of October. The Aug. 27 order requires six health plans (Alignment Health, Humana, SCAN…
A group of Republican lawmakers is pressing the Trump administration to step up enforcement of the No Surprises Act, citing ongoing problems with implementation and the IDR process. “We request the departments finalize clear and consistent QPA calculation methodology, accelerate…
Employers are gravitating toward “transparent” pharmacy benefit managers this year, according to a survey from the National Alliance of Healthcare Purchaser Coalitions. The 2025 “Pulse of the Purchaser” survey collated responses from purchasers and employers across the country. With nearly…