The American Medical Association voted to approve alternative payment model standards that “bolster rural hospital sustainability,” according to a Nov. 17 news release. Standards include scheduled fixed-cost payments, “adequate” rates for services that could fluctuate and appropriate patient cost-sharing. Payment…
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Emergency departments are increasingly overburdened by long wait times, complex patient cases and limited visibility into care history. But during a session at the Fall 2025 Becker’s Payer Issues Roundtable, participants argued that these transition points — if better coordinated…
UnitedHealthcare has filed a lawsuit against the director of the Idaho Department of Insurance, arguing that the state’s recent efforts to regulate Medicare Advantage plan marketing and broker commissions are in violation of the U.S. Constitution. The lawsuit, filed Nov.…
Ten providers recently posted job listings seeking leaders in payer contracting and relations. Note: This is not an exhaustive list. Listings were compiled from job-seeker sites. 1. Albany (N.Y.) Medical Center seeks a system payer contracting director. 2. Barton HealthCare…
CMS published its 2027 Medicare Advantage and Part D proposed rule on Nov. 25 that includes an overhaul of how star ratings are calculated, new enrollment flexibilities, and rollbacks of Biden-era health equity requirements. The proposed rule is subject to…
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ACA enhanced tax credits may best be described as a “will they or won’t they” — will Congress extend them past the end of the year, or are they on track to expire? While an extension could happen, the outcome…
Arkansas will see the largest percentage increase in average ACA benchmark premiums between 2025 and 2026, while Alaska is the only state where the average benchmark premium will decline, according to KFF. The U.S. average increase is 26%. Premiums were…
Cigna is joining a handful of other payers in CMS’ health technology “ecosystem,” according to a news release from the company. The CMS website said participants in the ecosystem agree to align on an interoperability framework for healthcare data and…
The American College of Physicians published recommendations for managed care Nov. 25 in the group’s flagship journal, Annals of Internal Medicine. Managed care plans, like HMOs and PPOs, are insurance models that focus on mitigating costs and utilization while maintaining…
The Illinois Department of Healthcare and Family Services launched home-visit coverage for pregnant and parenting Medicaid enrollees, effective Nov. 21. Under the initiative, the state covers some prenatal visits, including sessions for health education, blood pressure monitoring, behavioral health screenings,…