Guilty plea in UnitedHealthcare CEO killing comes amid sustained focus on obstacles to care
Luigi Mangione pleaded guilty Aug. 14 to federal stalking charges in the 2024 fatal shooting of UnitedHealthcare’s CEO, potentially bringing resolution to an incident that spurred introspection by insurers and the healthcare industry. The charges, stemming from the killing of Brian Thompson on Dec. 4, 2024, carry a maximum penalty of life in prison. Prosecutors…
HHS report raises scrutiny of gender-affirming care billing and coding
HHS followed up its final rule blocking Medicaid funding for gender-affirming care in minors by publishing a commissioned report alleging “potentially fraudulent” billing and coding among providers of the services. The report, released Aug. 13, alleges that financial incentives drove hospitals and physicians to expand access to the care, and that deceitful billing practices took…
The challenges of independent rural healthcare practices
Katie Gilfillan and Nick Hut discuss the latest on the value-based payment model landscape. Erika Grotto talks with Ziad Khoury, MD and Jason McKitrick about the challenges and opportunities in rural health. Further reading: Site-neutral payment debate in hospital policy | HFMA ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model | CMS Accountable Health…
Insurers, patients pay less of their bills
Healthcare providers faced growing challenges last year in getting paid for care among patients covered by insurance, according to new benchmark data from Kodiak Solutions. And it was both insurers and patients who were lagging in payment or not paying at all. Denials of coverage by health plans, already a problem in 2023, increased during…
5 key strategies for a successful mid-cycle
Today’s mid-cycle teams face mounting pressure. Oversight is tightening, payer policies are shifting rapidly and margins continue to shrink. This phase is no longer a simple pass-through, it’s a vital operational checkpoint that demands both strategic leadership and attention to detail. Hospitals that implement structure and prioritize accuracy tend to stay ahead. Those that don’t…
New CMS bundled payment initiative may be the future of Medicare
CMS's Transforming Episode Accountability Model (TEAM) is a new bundled payment model that aims to move Medicare beneficiaries into value-based care arrangements by 2030, and hospitals participating in the model will be financially responsible for the cost and quality of care for five procedures.
Bridging the payer-provider divide
No one wins when there is animosity between health plans and healthcare providers, least of all patients. They often must wait months to find out whether care will be covered and what their out-of-pocket cost will be as payers and providers negotiate the details.
5 revenue cycle management myths dispelled
The traditional healthcare revenue cycle was designed to evolve around payer reimbursement. Processes and workflows were pretty much set in stone. Step 1: register the patient; step 2: verify insurance and eligibility; step 3: capture the charges; step 4: code the claim, and so on. The lack of automation and interoperability solutions, especially electronic health…
Navigate the new norms in telehealth billing and coding practices
While telehealth has been around for decades, its adoption soared during the COVID-19 pandemic. According to the American Medical Association, telehealth use grew 70% in 2020. While the use of telehealth since then has leveled off, it remains a valuable and popular care option. More than half of patients surveyed said they prefer telehealth for…
Site-neutral payment has backing in healthcare policy circles, but its efficacy as a cost restraint is unclear
The concept of site-neutral payment continues to receive support from members of Congress and healthcare policy analysts, as demonstrated during a recent hearing. The Jan. 31 hearing of the House Energy and Commerce Committee’s Health Subcommittee was intended, in part, to promote pending legislation that would strengthen price transparency and implement other policies designed to…