Reimbursement

An automated process resulted in Humana instantly approving 70% of prior authorization requests, says Greg LeGrow, executive director of payer product market strategy at athenahealth, and Mark Fleming, senior director of product at Availity.

Higher Medicare and Medicaid reimbursement is one step the federal government can take to preserve rural care access, CEOs say.

Half of adults who challenged coverage denials reported success in getting some or all denied services approved, survey shows.

For 2025, CMS is increasing the long-term care hospital standard payment rate by 3%.

CMS did not finalize the ability for follow-up visits to be conducted by telehealth.

The government subsidy to Part D plans is shifting from being reconciled on the backend to a larger risk-adjusted payment upfront.

Cody Coonradt, Billy’s CEO and founder, says patients are now able to negotiate prices for medical procedures and lower their bills by having location-based access to hospital pricing data.  

The plaintiffs claim that Change failed to implement cybersecurity safeguards such as multifactor authentication.

The hybrid payment structure may result in payment decreases that cannot be absorbed, the AHA said.

AI can mine data to identify patterns in a patient’s history, access medical records to automate claims and lead to a self-service model, say Oron Afek, CEO of Vim and Ashok Chennuru, global chief data and insights officer, Elevance Health.