Major insurers pledge prior authorization reform
Editor's Note Nearly 50 major US health insurers—including UnitedHealthcare, Aetna, Cigna, Elevance, and Humana—have pledged to reform prior authorization practices, with the goal of easing administrative burdens and improving access to care, according to a June 23 article in Healthcare Dive. As detailed in the article, the announcement came from…
Bad debt climbs as patient defaults, denials impact hospital revenue growth
Editor's Note Bad debt—payments hospitals expected to collect but ultimately had to write off—is increasing across hospitals as patients struggle to pay their share of healthcare costs and insurers raise the rate of claim denials, Modern Healthcare reported June 19. Citing a Kaufman Hall analysis of data from about 700…
Low-income patients face uphill battle overturning insurance claim denials, study shows
Editor's Note Patients earning less than $50,000 annually are significantly less likely to have denied insurance claims reversed compared to wealthier individuals, according to a new study published in Health Affairs and reported by Fierce Healthcare on June 5. Researchers from the University of Massachusetts Amherst and the University of…
Providers push back on insurance cost-cutting hurdles
Editor's Note Escalating administrative hurdles from insurers are heightening tensions between healthcare payers and providers who criticize the measures for threatening patient care, Modern Healthcare reported January 22. According to the article, policies attracting criticism include stringent prior authorization rules, claims denials, and new fees for appeals. For their part,…
AHA's Congressional "wish list" calls for financial relief, patient access, workforce protections
Editor's Note In a November 12 letter to Congress, the American Hospital Association (AHA) outlined its priorities for the lame-duck legislative session, focusing on measures to stabilize hospitals and health systems facing significant financial and operational pressures. If enacted, these recommendations would support the nation’s healthcare infrastructure amid rising…
Medicare Advantage insurers prioritize profits over patients, Senate reports
Editor's Note A Senate report reveals that Medicare Advantage insurers are increasingly prioritizing profits over patient care by ramping up the use of prior authorization to deny necessary services, particularly post-acute care, for older adults, Becker’s Hospital Review reported October 17. In May 2023, the Senate Permanent Subcommittee on Investigations…
Private payers profit by delaying medical claims
Editor's Note Private payers initially deny reimbursement on 15% of claims, only to later approve more than half of those initial denials, according to a national survey of healthcare institutions published March 21 by Premiere, Inc. Additionally, the denied claims on average tend to be more prevalent for higher-cost treatments…
Problems with prior authorization, utilizing health insurance coverage are prevalent, survey finds
Editor's Note This KFF survey from June 2023 found that some six in 10 adults with health insurance have experienced problems when trying to use their insurance, KFF Health News September 29 reports. The problems included denied claims, network adequacy issues, and preauthorization delays and denials. According to the survey,…
Free Daily News
- Large-scale studies link preoperative cognition to delirium risk, reveal its deadly toll after surgery
- Socioeconomic deprivation linked to lower fitness before surgery, UK study finds
- Perioperative medication decisions need individualized risk-benefit approach
- FDA: National IV saline shortage over after years of strained supply
- FDA announces Class 1 recall for Draeger breathing filters
- Hospital CEO departures surge, boards turn to interim leadership
- Study: Attire shapes patient trust, perceptions
- ASC drill success hinges on preparation, adaptability, clear roles
- Robotic surgery shows better outcomes in select emergency colorectal cases, poised for wider use
- 5 costly mistakes to avoid when building an ASC