The Latest - Page 7 of 1400 - Becker's Payer Issues

Stop Buying Recommendations. Start Buying Results: Why more hospitals are replacing traditional consulting with managed partnerships

Traditional consultants deliver reports and recommendations — then leave hospitals to figure out the rest. It’s a model that’s falling short in today’s healthcare environment. That’s why hospitals are shifting toward co-managed partnerships. These models embed clinical and operational leaders…

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Presented by:

Presenters

John Birkmeyer, MD

President, Medical Group, Sound Physicians

Roberta Luskin-Hawk, MD

Regional President, Sound Physicians

Melissa Buchner-Mehling, MD, CHCQM, CPHYADV, FABQAURP

Associate Chief Medical Officer, Sound Physicians

Staying ahead of OBBBA: Tools and strategies to protect patients and strengthen RCM

The One Big Beautiful Bill Act (OBBBA) will slash Medicaid spending by $900 billion over the next decade with an estimated 7.5 million people losing coverage. These shifts will hit health systems hard, especially those serving Medicaid expansion and undocumented…

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Federal watchdog reports ACA fraud risk

The U.S. Government Accountability Office found significant fraud risk in the ACA application process, according to a Dec. 3 agency report. Auditors applied for coverage under fictitious identities to test marketplace enrollment controls. The marketplace approved coverage for the four…

Aetna merges prescriptions, procedures into single prior authorization

Aetna is bundling pharmacy prescriptions and medical procedures into a single clinical review, according to a Dec. 4 news release. Providers previously had to submit two prior authorizations, but, as of November, providers only have to file one medical review,…

The $25B Medicaid threat: How hospitals are fighting back

The One Big Beautiful Bill Act is poised to slash Medicaid revenue by $25 billion annually, a 70% drop in operating margin for the average hospital. With redeterminations moving to every 6 months, patients are losing coverage. Payers are escalating…

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Weight loss drug coverage under commercial plans: 5 things to know

The Trump administration introduced plans to lower obesity drug costs for Medicaid and Medicare, but commercial insurance coverage of GLP-1s remains a concern. “There is some speculation that this initiative will help create downward pressure for drug manufacturers to lower…

New Jersey enacts insulin, inhaler, EpiPen out-of-pocket caps

New Jersey has finalized rules requiring state-regulated insurers to cap out-of-pocket costs on insulin, asthma inhalers and epinephrine auto-injectors. The state published the final regulations Dec. 1, implementing legislation Gov. Phil Murphy signed that made New Jersey the second state…

Zing Health sues CMS over Medicare Advantage contract termination

Medicare Advantage insurer Zing Health has filed a new lawsuit against HHS and CMS, alleging the agencies failed to remedy harms caused by its improper termination from the MA program last year. The insurer filed the complaint Nov. 26 in…

One year after CEO's killing, UnitedHealth navigates a financial reset

The 12 months since UnitedHealthcare CEO Brian Thompson was fatally shot have been among the most turbulent in UnitedHealth Group’s history. The company has cycled through senior executives, disclosed billions in unexpected medical costs, confirmed it is under criminal investigation…

UConn Health out of network with Aetna

Farmington-based University of Connecticut Health’s contract with Aetna expired Dec. 1. UConn Health, including John Dempsey Hospital and the UConn Medical Group, will no longer be covered. This status does not apply to retirees of state government employment and Aetna…