Payer

At the first Becker’s Payer Issues Roundtable event on November 7-8, a leadership panel discussed payers’ top priorities.

CMS' Dec. 6 proposal to improve the prior authorization process was met positively from groups ranging from America's Health Insurance Plans to the Medical Group Management Association. 

Payment fraud can seem like an existential threat to payers. The reality is that healthcare payments are a constant target for payment fraud, and payers drive many of the transactions that are the most valuable to fraudsters, including claim payments…

CMS issued a proposed rule that it says will streamline the prior authorization process and estimates the efficiencies introduced in the proposal would save hospitals and physician practices more than $15 billion over a 10-year period. 

Centene will pay Oregon $17 million to settle allegations the payer overcharged the state's Medicaid program for pharmaceutical services, the Oregon Justice Department said Dec. 6. 

The No Surprises Act, which protects consumers from out-of-network charges for emergency care and other services, took effect Jan. 1 of this year. 

The $25 billion in federal funds given to healthcare providers over the course of the pandemic is drying up, which could leave the nearly 30 million uninsured Americans footing the bill for their future COVID-19 care, The New York Times…

Deductibles can deter women from seeking additional screening after abnormal findings on a mammogram, a study presented Nov. 29 at the Radiological Society of North America found. 

Many local commercial and exchange markets are largely controlled by one payer, according to the American Medical Association. 

Medicare Advantage plans have faced scrutiny for possible upcoding and pressure to update provider directories. Here are nine Medicare Advantage updates Becker's has reported since. Nov. 18.