Uncategorized

Insurer Use of Prior Authorization Down

The insurance industry appears to be making good on its pledge to reduce its use of prior authorization for services and to make that process simpler for providers and patients Last June, some of the leading health insurers agreed to work to address prior authorization challenges. Now, an AHIP-Blue Cross Blue Shield Association survey has found that they have reduced by 11 percent the number of procedures and services that require prior authorization, which translated into 6.5 million fewer requests. Medicare Advantage plans went even further, eliminating 15 percent of procedures and services that require prior authorization. In addition, the [...]

joe2026-04-08T13:38:49-04:00April 10, 2026|Uncategorized|

FTC Creates Health Care Task Force

A new group will join the fight to protect Americans from their country’s health care system. The Federal Trade Commission has announced the creation of a health care task force “…that will engage in a coordinated, integrated approach to healthcare enforcement and advocacy to protect American patients, healthcare workers, and taxpayers.” According to the FTC, the task force will: Lead targeted enforcement and advocacy initiatives focused on key priorities; Devise coordinated agencywide strategies on investigations; Take a proactive and strategic approach to identifying amicus and statement of interest opportunities; and Identify emerging issues and new priority areas for enforcement and [...]

joe2026-03-24T14:29:41-04:00March 26, 2026|Uncategorized|

CMS Takes an Axe to the Fax

The days of sending health care claims forms and claims-related documents by fax and regular U.S. mail are fast drawing to a close. Last week the Centers for Medicare & Medicaid Services announced that it will adopt a new regulation – “The Administrative Simplification; Adoption of Standards for Health Care Claims Attachments Transactions and Electronic Signatures Final Rule” – that will establish HIPAA-compliant standards for sharing health care claims attachments, enabling the secure electronic exchange of health care claims-related supporting clinical documentation and attachments such as medical records, x-rays and imaging, clinical notes, telemedicine visit documentation, and laboratory results. The [...]

joe2026-03-24T13:44:33-04:00March 25, 2026|Uncategorized|

No Surprises Act Activity in 2025

A new Health Affairs report offers a preliminary look at No Surprises Act Independent Dispute Resolution activity for 2025. Among its findings: Providers and facilities initiated 99.9 percent of the disagreements submitted to the IDR process. Four provider groups or representatives of provider groups initiated more than half of those cases. Providers prevailed in 88 percent of the cases. Health plans challenged 40 percent of the cases submitted to the IDR process as ineligible for adjudication under that process. The IDRs upheld their challenges only 17 percent of the time. Health plans are starting to sue those submitting large numbers [...]

joe2026-03-24T16:48:35-04:00March 25, 2026|Uncategorized|

Looking Ahead to New Health Plan Price Transparency Requirements

If the new health plan price transparency requirements proposed by the Centers for Medicare & Medicaid Services are finalized later this year and implemented a year later, as anticipated, they will usher in significant changes in available data for use by consumers, providers, and businesses that collect, analyze, package, and sell such data. The anticipated changes in transparency requirements could include: Specific identification of rate changes from the most recently published rate. Reduced file sizes that eliminate some currently required data and a requirement that health plans post a single in-network file for each provider network instead of a file [...]

joe2026-03-19T17:26:12-04:00March 24, 2026|Uncategorized|

Groups Protest No Surprises Act Implementation

A group of more than 60 health care payers, employer groups, and others have written to the departments of Health and Human Services, Labor, and the Treasury to protest how the Independent Dispute Resolution process created under the No Surprises Act is deciding pay disputes between providers and insurers. The letter accuses payers of using the Independent Dispute Resolution process as a money-making tool. It also maintains that the panels deciding the disputes are favoring providers – which are winning 85 percent of the cases they consider – and are operating without sufficient guidance from federal regulators. It also notes [...]

joe2026-02-25T13:05:12-05:00February 26, 2026|Uncategorized|

Rate of Timely Prenatal Care Declines

The rate at which pregnant women start receiving prenatal care during their first trimester declined between 2021 and 2024, as did the rate of pregnant women who received late or no care. Meanwhile, the rate at which pregnant women initiated prenatal care during their second trimester rate rose. These figures come from a new data brief from the Centers for Disease Control and Prevention’s National Center for Health Statistics. Highlights from the CDC’s findings, taken directly from the report, include: After increasing from 2016 (77.1%) to 2021 (78.3%), prenatal care beginning in the first trimester decreased to 75.5% in 2024. [...]

joe2026-02-19T16:28:49-05:00February 23, 2026|Uncategorized|

Providers Continue to Dominate Fee Dispute Resolution

Health care providers won the vast majority of the fee disputes adjudicated through the No Surprises Act’s Independent Dispute Resolution process during the first half of 2025. The volume of those disputes submitted to arbitration rose nearly 40 percent over the first half of 2024, to 1.2 million cases, and the victory rate of providers also rose, from 85 percent to 88 percent.Leading the way for providers were private equity-backed parties, with three such companies accounting for 44 percent of the disputes submitted during the first half of 2025 and ten of those companies filing nearly 70 percent of all [...]

joe2026-01-28T13:02:20-05:00January 29, 2026|Uncategorized|

Controversy Over No Surprises Act Continues

Providers and payers continue to wage war over how the No Surprises Act is being implemented. The law, enacted in 2020, was intended to prevent insured consumers from receiving surprise medical bills, especially for out-of-network care. While it has achieved that objective to a considerable degree, it has left behind providers complaining they are being underpaid for their services and payers – health insurers – insisting that the process of adjudicating such disputes, through what is known as the Independent Dispute Resolution process, is forcing them to pay far too much for providers’ services. At the heart of the debate [...]

joe2025-12-17T12:57:49-05:00December 18, 2025|Uncategorized|

Federal Health Policy Update for November 20

The following is the latest health policy news from the federal government for November 14-20. Some of the language used below is taken directly from government documents. Medicare and Telehealth In guidance issued Thursday afternoon, CMS notes that on November 6 it instructed the MACs to return a subset of telehealth claims submitted on or before November 10 that at that time were no longer payable because the statutory provisions temporarily suspending various Medicare telehealth requirements expired on October 1 or were claims CMS could not identify as payable under current law. Now, practitioners may resubmit those returned claims to [...]

joe2025-11-21T11:57:00-05:00November 20, 2025|Uncategorized|