New & Notable
New CMS rule ties Medicare billing privileges to owners’ misconduct
The rule targets providers owned by companies with violations in other programs and requires reenrollment for home health and hospice providers following a major ownership change.
Medicare will cut billions from 340B, expand site-neutral payments in 2027
Regulators finalized a rule Wednesday that would slash payments for drugs in the controversial 340B program and equalize some payments between care sites. Hospitals railed against the rule.
— Healthcare Dive
Medicare finalizes physician pay cut for 2027
Regulators trimmed doctors’ Medicare payments and hammered out other policies to reduce duplicative reimbursement. Providers slammed the cuts, saying they would further destabilize the sector.
— Healthcare Dive
Medicare spends more on hospices owned by private equity firms, study finds
A Health Affairs study found private equity-owned hospices had longer lengths of stay and admitted more low-intensity patients, raising concerns about profit-driven care decisions.
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Healthcare Strategies: A Podcast
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A podcast for healthcare professionals seeking solutions to today's and tomorrow's top challenges. Hosted by the editors of Xtelligent Healthcare Media, this podcast series focuses on real-world use cases that are leading to tangible improvements in care quality, outcomes, and cost.
Guests from leading provider, payer, government, and other organizations share their approaches to transforming healthcare in a meaningful and lasting way.
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Latest News
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CMS prior auth pilot shrinks service use amid public backlash
A pilot that applies AI-driven prior authorizations to high-volume Medicare services has reduced utilization in its first six months, according to new research.
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75% of health systems face rising claim denial rates
Health systems are focused on lowering claim denial rates ahead of a growing uninsured rate, with many considering AI to reduce errors and drive efficiency.
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RevSpring debuts AI agent for personalized payment plans
A new conversational AI agent will integrate with RevSpring's patient payment portal to offer personalized payment plans and answer common questions from consumers.
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Patient liability drives about half of hard-to-collect bills
A new analysis finds that patients owe more on large medical bills, creating larger obstacles for providers to collect these notorious costs.
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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.
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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.
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.