New data on No Surprises Act IDR cases show providers won often in 2025
Providers and their intermediaries continued to flourish in the No Surprises Act’s independent dispute resolution (IDR) process during the second half of 2025, according to newly released data from the federal departments overseeing IDR. Among 1.15 million disputes that received payment determinations during the six-month period, providers won 85%. That share generally tracked trends seen…
MultiPlan antitrust litigation gains momentum after rulings for providers
Healthcare providers obtained two favorable rulings over the last month in their massive antitrust litigation against a vendor’s repricing algorithm. The case entails allegations that MultiPlan — which since has rebranded as Claritev — conspired to set out-of-network (OON) payment rates by gathering competitively sensitive information from roughly 700 health plans and using that information…
A key election question: What will happen to the enhanced Affordable Care Act subsidies?
Earl Pomeroy knows from experience that the politics surrounding the Affordable Care Act (ACA) are dicey. As a Democratic member of the House Ways and Means Committee, Pomeroy helped pass the ACA during his ninth term representing North Dakota. After that, “I lost my job,” he recalled. Since his time in Congress ended with his…
The courts continue to favor providers in No Surprises Act litigation, this time at the appellate level
After a string of victories in federal district court, a medical association’s success at contesting aspects of the No Surprises Act’s arbitration process recently continued at the appellate level. In an Aug. 2 ruling, the U.S. Court of Appeals for the Fifth Circuit upheld a lower court’s finding that regulations issued in 2022 gave too…
As providers seek resolution of continuing Change Healthcare issues, UnitedHealth Group reports strong financials
The aftermath of the Change Healthcare cyberattack affected the second-quarter financials of parent company UnitedHealth Group (UHG), but not to the point of hindering the company’s continued “diversified and durable growth,” CEO Andrew Witty said during a recent investor call. Q2 revenues increased by 6% year-over-year, while profits dropped by 5.5% amid costs stemming from…
Annual Conference Day 3: UnitedHealth, Optum executives discuss resilience strategies for healthcare
Especially after being on the front lines of the most impactful cyberattack to hit the healthcare industry, leaders with UnitedHealth Group (UHG) and Optum have plenty of thoughts on how stakeholders can shore up their defenses. UHG is the parent company and Optum a sister company of Change Healthcare, which was the target of a…
Congress seeks to keep the momentum going on improvements to prior authorization
Members of Congress are revitalizing efforts to pass legislation that would streamline prior authorization in Medicare Advantage (MA). A bipartisan, bicameral group of legislators reintroduced the Improving Seniors’ Timely Access to Care Act, a bill that unanimously passed the House in September 2022 but did not receive a vote in the Senate. One obstacle at…
Hospital payments have been substantially affected by the Change Healthcare cyberattack, report finds
Newly published data reflect the extent of the payment loss experienced by hospitals and health systems during the first month or so after the Change Healthcare cyberattack. A report (registration required) published in mid-May by Strata finds that gaps in expected revenue ranged from 16.5% to 17.9% per hospital for Q1. The insights were culled…
The federal policy response to the Change Healthcare cyberattack
Note: This information is excerpted from HFMA’s running coverage of the cyberattack that disabled operations at Change Healthcare. On March 10, HHS and the Department of Labor sent a letter encouraging commercial payers to do their part to help financially strained providers nearly three weeks after the cyberattack on Change Healthcare. “Larger payers in particular…
Cyberattack on Change Healthcare brings turmoil to healthcare operations nationwide
This blog presents HFMA’s running coverage of the Change Healthcare cyberattack and its impact on providers and the healthcare industry. July 29 updates A recent HFMA news article examined both UnitedHealth Group’s latest quarterly financial report and lingering issues for providers amid the ongoing cyberattack recovery. Receiving electronic remittance advice files remains a problem with…