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Medicare Advantage in the headlines: 6 recent updates
Newly released court documents show CMS dropped a proposal to require Medicare Advantage plans to return overpayments a decade ago, and J.D. Power published its annual ranking of the top MA plans. -
Blue Shield of California fined over contraceptive copays
Blue Shield of California will pay $250,000 to California for charging members copays for contraceptive services. -
Inefficiencies in RCM Can Sink Hospital Finances: Reimagine Medical Coding with RapidClaims AI
In an era where healthcare margins are razor-thin, inefficiencies in Revenue Cycle Management (RCM) can devastate hospital finances. It’s estimated that U.S. hospitals lose up to $262 billion annually due to revenue cycle inefficiencies, with medical coding being one of the primary culprits. The consequences are clear: missed revenue opportunities, prolonged A/R days, and ballooning denial rates. But what if there was a way to automate coding with unparalleled accuracy, speed, and cost-effectiveness? Enter RapidClaims. -
Best health insurance brands in 2024
Six health insurance brands are among Newsweek's top 604 corporate brands in America. -
UnitedHealth: 5 concerning, 4 positive trends in maternal health
While some measures of maternal health are improving, deep disparities remain in health outcomes and drivers, according to the UnitedHealth Foundation's America's Health Rankings Maternal and Infant Health Disparities Data Brief. -
Centene to end Part D broker payments
Centene will no longer pay commission to insurance brokers enrolling or renewing members in its Medicare Part D plans. -
CMS awards $100M to ACA navigators
CMS has awarded $100 million to organizations that help individuals enroll in ACA marketplace coverage. -
CMS scrapped Medicare Advantage rule over industry opposition: Report
CMS dropped a proposed regulation that would have required Medicare Advantage plans to return overpayments found during chart reviews over industry opposition, KFF reported Aug. 27. -
Counties ranked by narrowest ACA networks
ACA enrollees in Cook County, Illinois have access to 14% of local physicians, according to an Aug. 26 analysis from KFF. -
Revolutionizing payment accuracy: The future of payment integrity
The continued rising cost of healthcare is prompting many health plans to take a closer look at the value strong payment integrity programs can drive. -
What happens when Medicare Advantage contracts are terminated?
Around 1 in 5 Medicare Advantage beneficiaries switch to traditional Medicare when their plans shut down, a study published Aug. 20 in JAMA Network Open found. -
CareFirst, Johns Hopkins launch AI accelerator
CareFirst BlueCross BlueShield, Johns Hopkins University and Techstars will partner on an accelerator program to launch new healthcare-focused AI companies. -
States ranked by Medicaid spending per enrollee
Washington, D.C. has the highest Medicaid spending per enrollee, while Tennessee has the lowest, according to an Aug. 16 report from KFF. -
Direct contracting grows: 6 key numbers
As healthcare costs continue to rise, a growing number of employers are exploring alternative payment models such as direct contracting, where the employer contracts directly with a provider for employee care. -
Alabama state health plan warns of funding shortfall
Alabama's state employee health plan is facing a projected loss of about $20 million in fiscal year 2025, the Alabama Reflector reported Aug. 22. -
BCBS Minnesota must face ERISA lawsuit from Labor Department, judge rules
A federal judge has ruled that Blue Cross and Blue Shield of Minnesota must face a lawsuit from the U.S. Labor Department accusing the payer of incorrectly imposing a state provider tax on self-funded health plan customers and violating its fiduciary duties under ERISA. -
Employers are worried about GLP-1s — most cover them anyway
Two-thirds of employers surveyed by the Business Group on Health cover GLP-1 drugs to treat obesity. -
How Congress members get their health insurance
Members of Congress are tasked with making decisions about the future of the ACA exchange — and they also receive their healthcare benefits through it. -
OIG: Elevance subsidiary received $59M in Medicare Advantage overpayments
MMM Healthcare, a Puerto Rico subsidiary of Elevance Health, received $59 million in net Medicare Advantage overpayments for 2017, according to an audit from HHS' Office of Inspector General published Aug. 14. -
10 states reforming prior authorization in 2024
Ten states have passed laws reforming the prior authorization process, according to an Aug. 19 report from the American Medical Association.
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