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…
New data shows providers continuing to win most No Surprises Act independent dispute resolution cases
Providers won a large majority of disputes initiated during the first half of 2023 through the No Surprises Act’s arbitration portal for adjudicating out-of-network payments, according to newly published data. HHS and the U.S. Departments of Labor and Treasury released public-use files (available to download here under “2023 Reporting Year”) showing the outcome of every…
CMS’s 2025 advance rate notice for Medicare Advantage brings potential concern for providers
Medicare Advantage (MA) health plans are projected to reap a 3.7% revenue increase in 2025, but provider payments could be affected by a decrease in plan benchmarks, per data shared in CMS’s annual advance notice. If finalized, the estimated 0.16% average reduction in base payments to plans could have consequences for care delivery, one provider…