Healthcare stakeholders are invited to contribute suggestions for improving prior authorization
A two-month comment period is available for healthcare stakeholders to suggest electronic standards that would make the prior authorization process more efficient.
Coverage denials based on medical necessity are far more likely to arise from Medicare FFS rules than from MA plan policies
Coverage rules stemming from Medicare national and local determinations were the most likely cause of claim denials in one Medicare Advantage plan.
New surprise billing regulations: Assessing a patient’s network status will be a key challenge
With new surprise billing regulations in place, providers should seek to implement efficient processes for gauging whether a patient is in-network.
2 new studies illustrate the burden of healthcare costs in the pandemic era
An annual report by CMS actuaries quantified the extent to which healthcare costs accelerated during the first year of the COVID-19 pandemic, while a separate survey looked at affordability.
Healthcare News of Note: A majority of physicians fear they missed signs of drug misuse during the pandemic and predict drug overdose deaths will rise, says a Quest Diagnostics report
Healthcare News of Note for healthcare finance professionals is a roundup of recent news articles: Physicians fear they missed signs of drug misuse during the pandemic, improved technology use is seen in patient engagement, and the majority of Medicaid health plans have a health equity plan.
Hospitals, physicians file lawsuit over the arbitration process in the new surprise billing regulations
Leading provider associations have asked a federal court to halt the incorporation of criteria that appear to favor insurers over providers in an arbitration process to determine out-of-network payment amounts.
News Briefs: Federal vaccination requirements finalized for hospitals and most other healthcare settings
If a hospital’s staff aren’t fully vaccinated by Jan. 4, the organization will be deemed noncompliant with Medicare and Medicaid regulations, according to a new federal rule.
Healthcare provisions in massive legislation could improve care access but also reduce federal funding for some hospitals
In pending legislation, reductions to disproportionate share hospital payments would be used to subsidize commercial insurance for low-income residents of states that haven’t expanded Medicaid.
The pandemic cast a new light on mental health, and telemedicine provided a new avenue to access. How is the industry likely to view mental health and behavioral health in the future?
Dr. Ranga Krishnan of Rush University System for Health discusses the future of mental health payment and practice. He addresses how provider organizations can address workforce shortages by becoming partners in training and by changing the way they provide care to patients. He also talks about improving mental and behavioral healthcare in a value-based payment environment.
Additional requirements are needed to make healthcare price transparency worthwhile, report states
Updates to price transparency regulations should address compliance and formatting and incorporate new data elements.