New & Notable
Feds nab 6 providers in $2B healthcare fraud takedown
The Justice Department charged 15 people in its latest healthcare fraud sweep, adding billions more to its running tally of $6.5 billion in false claims this year.
Newly published NSA audits reveal QPA miscalculations
Two recently published audits of No Surprises Act claims uncovered troubles two plan sponsors have had with calculating the QPA, a highly criticized metric in the IDR process.
Provider-sponsored health plans negotiate lower rates
New research shows health systems with their own insurance plans negotiate significantly cheaper rates, but researchers warn against treating the model as a blueprint for savings.
RFK Jr. gives CMS authority to ban individual providers
The head of the CMS can now exclude healthcare providers from receiving federal healthcare funds, an authority once reserved for the HHS OIG.
Hospitals sue over revamped 340B rebate pilot
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Latest News
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Feds nab 6 providers in $2B healthcare fraud takedown
The Justice Department charged 15 people in its latest healthcare fraud sweep, adding billions more to its running tally of $6.5 billion in false claims this year.
-
Newly published NSA audits reveal QPA miscalculations
Two recently published audits of No Surprises Act claims uncovered troubles two plan sponsors have had with calculating the QPA, a highly criticized metric in the IDR process.
-
Provider-sponsored health plans negotiate lower rates
New research shows health systems with their own insurance plans negotiate significantly cheaper rates, but researchers warn against treating the model as a blueprint for savings.
-
RFK Jr. gives CMS authority to ban individual providers
The head of the CMS can now exclude healthcare providers from receiving federal healthcare funds, an authority once reserved for the HHS OIG.
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How Medicare calculates site-neutral rates matters, research says
Site-neutrality is now a question of when, not if, and research shows that how Medicare calculates the rates could affect some service lines more, despite similar overall savings.
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Hospital price transparency is clearer, but gaps persist
An analysis finds five persistent issues with hospital price transparency files that continue to hinder price comparisons despite new guidance aiming to clarify costs.
Features
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Payers say AI doesn't deny care. The truth is more complex.
Payers say AI is not clicking the deny button on prior authorizations and provider claims, but the technology does play a key role in deciding which requests need further review.
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How providers can weather Medicaid cuts when many won't
Federal Medicaid reform will affect providers differently, with some more at risk of closing while others can innovate their way out of severe revenue losses.
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Prior authorization automation hinges on human connection
Healthcare is rapidly automating the prior authorization process, but Ochsner Health has found that a new initiative connecting payers and providers is making progress tangible.
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What providers really need to streamline prior authorizations
Providers have yet to see much progress on a pledge last year to streamline prior authorizations, signaling misalignment between payer promises and meaningful change for providers.