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…
Report: Payer requests for information are slowing reimbursement
Payers are increasingly rejecting claims through requests for information (RFI) that in total serve no purpose other than to delay reimbursement, according to “Death by a thousand requests,” a report from consulting firm Kodiak Solutions. RFI claim denial rates as a percentage of total billed charges climbed to 3.82% in 2024 through May, up from…
Mandatory Medicare bundled payments and respiratory disease reporting are on the way for hospitals
Hospitals in nearly a quarter of U.S. markets soon will be required to participate in a Medicare bundled payment model covering five surgical procedures, CMS said in newly released regulations. The model is among several policies of note in Medicare’s FY25 final rule for hospital inpatient care and long-term care hospitals. See this previous article…
Hospitals will get only a small bump in Medicare inpatient payments for FY25
Hospital representatives were less than excited about the rate update in Medicare’s FY25 final rule for inpatient care and long-term care hospitals. Published Aug. 1, the rule includes a 2.9% rate increase for acute care hospitals in the fiscal year that begins Oct. 1. The increase is derived from a 3.4% hike in the market…
The fate of the FTC’s ‘noncompete’ rule appears muddled after early court decisions (updated)
Aug. 20 update: This article has been updated with news that a court has halted the FTC’s rule from taking effect. See the update below. A highly scrutinized rule prohibiting employers from using noncompete agreements has received a mixed reaction in the courts during the leadup to its implementation. Set to take effect Sept. 4,…
Ramifications of a proposed rule to halt credit reporting of medical debt
A proposed rule from the Consumer Financial Protection Bureau (CFPB) would curtail the inclusion of medical debt in credit evaluations, potentially shaking up healthcare billing and collections processes. The CFPB framed part of its rationale for the June 11 rule in the context of privacy, noting Congress previously limited the sharing of a patient’s medical…
Appeals court eliminates Medicare supplemental payments for low-wage hospitals (updated-2)
Note: This article was updated most recently Oct. 4 with news that CMS has ended the low-wage-index policy. See that update below. Plaintiff hospitals won litigation last week at the federal appellate level that will adversely affect Medicare payment for some rural hospitals. The U.S. Court of Appeals for the D.C. Circuit backed a district…
UChicago Medicine grows into role of AI innovator
UChicago Medicine discovered that they are ahead of other healthcare institutions in their use of AI for revenue cycle, and they are focusing on using AI to strengthen business outcomes, supporting a culture of AI innovation, implementing a governance framework, and measuring and optimizing performance.
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…
What have we agreed to? Cutting the knot with AI
In ancient Greek legend, the Gordian knot was a knot of extreme complexity that tied an oxcart to a post. Whoever could untie the knot was destined to become the ruler of Asia. By a popular account, when Alexander III of Macedonia (later Alexander the Great) was challenged to untie the knot, he came up…