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States Not Depending on Federal Action on Prior Authorization

Unwilling to leave the challenge of addressing the troubling prior authorization practices of many health insurers, officials in some states are trying to take matters into their own hands. Last year, lawmakers in 29 states considered 90 different bills to impose varying prior authorization requirements on health insurers serving their constituents. Among the changes these proposals seek: shorter response times for requests for authorization and mandatory public reporting of insurers’ prior authorization activity. In addition, last year five states required insurers to engage in a practice known as gold carding: waiving prior authorization for requested items and services for individual [...]

joe2024-02-13T16:56:53-05:00February 14, 2024|Uncategorized|

Lack of Instructors Impedes Fixing Nurse Shortage

The current shortage of nurses across the U.S. can be traced in part to the lack of training opportunities for aspiring nurses and not to a lack of people seeking to pursue nursing as a career. Last year U.S. nursing programs rejected nearly 80,000 qualified applicants because they did not have the capacity train them. Driving this problem are three major challenges. First is the lack of nursing school faculty: nearly 2000 full-time faculty positions remain unfilled, and many part-time positions as well, a problem caused by low salaries; working nurses often earn much more than nursing instructors. Another complication: [...]

iqtsupport2023-10-11T13:00:09-04:00October 11, 2023|Uncategorized|

CMS Warns States About Medicaid Renewals

Some states are falling short in their efforts to process Medicaid renewal applications and are inappropriately finding too many people ineligible to continue participating in the program, the Centers of Medicare & Medicaid Services has written in a letter it sent to all 50 states. In this letter, CMS wrote that As the Centers for Medicare & Medicaid Services (CMS) has worked with states on the return to regular eligibility operations following the end of the Medicaid continuous enrollment condition, we have identified issues where states are out of compliance with renewal requirements. CMS has worked with those states individually [...]

iqtsupport2023-09-05T06:00:57-04:00September 5, 2023|Uncategorized|

No Surprises Act’s Dispute Resolution Suspended

When a federal court in Texas rejected an increase in the fee for providers to initiate payment challenges under the No Surprises Act’s Independent Dispute Resolution process, the Centers for Medicare & Medicaid Services quickly suspended use of that process while it reviewed the court ruling – suspended both the adjudication of current complaints and the filing of new ones. Almost as quickly, CMS announced that it would reduce the fee required to initiate payment disputes between providers and payers under the 2020 law that sought to prevent surprise medical bills from $350 to $50 – but it did not [...]

iqtsupport2023-08-18T06:00:20-04:00August 18, 2023|Uncategorized|

No Surprises Act Arbitration Decisions Resume

After revising its guidelines on how certain medical fee disputes should be resolved, the Centers for Medicare & Medicaid Services has directed the Independent Dispute Resolution entities responsible for arbitrating fee disputes between payers and providers to resume making and issuing their decisions. After a February ruling in federal court that aspects of CMS’s implementation of the 2020 No Surprises Act contradicted the language of the act itself and unfairly favored payers over providers, CMS ordered a moratorium on new arbitration decisions for disputes filed on or after October 25, 2022 while it reviewed and revised its guidance on how [...]

iqtsupport2023-03-22T13:00:58-04:00March 22, 2023|Uncategorized|

Some Surprise Billing Dispute Decisions to Resume

The Independent Dispute Resolution entities empowered by the No Surprises Act of 2020 to adjudicate disagreements between providers and payers may resume their work – but only some of it. According to the Centers for Medicare & Medicaid Services, On February 24, 2023, certified IDR entities were instructed to resume processing payment determinations on February 27, 2023, for disputes involving items or services furnished before October 25, 2022. But CMS also announced that Certified IDR entities will continue to hold issuance of payment determinations that involve items or services furnished on or after October 25, 2022 until the Departments issue further [...]

iqtsupport2023-02-28T06:00:13-05:00February 28, 2023|Uncategorized|

Surprise Billing Law Stumbles in Court

A federal judge in Texas has vacated part of the arbitration process that is a major aspect of the No Surprises Act, the federal law enacted to reduce surprise medical bills. In the wake of this ruling, the Department of Health and Human Services has directed the entities charged with mediating payment disagreements to stop making decisions. In the Texas case challenging the fairness of the independent dispute resolution process that is a key component of the surprise billing law’s implementation, the federal judge found that the arbitration process unfairly favored payers over providers, most notably by placing undue emphasis [...]

iqtsupport2023-02-14T06:00:22-05:00February 14, 2023|Uncategorized|

Hospitals Improving Electronic Data Exchange

Hospitals are improving their interoperability and doing a better job of exchanging health data electronically, according to a review by the federal Office of the National Coordinator for Health Information Technology (ONC). According to a new ONC report, In 2021, more than 6 in 10 hospitals engaged in key aspects of electronically sharing health information (send, receive, query) and integrating of summary of care records into EHRs, a 51 percent increase since 2017. Availability and usage of electronic health information received from outside sources at the point of care significantly increased over the last four years, reaching 62 and 71 [...]

iqtsupport2023-01-31T06:00:22-05:00January 31, 2023|Uncategorized|

States Look to Take on Prior Authorization

The majority of states may act on insurer prior authorization practices in the coming year and even though the year is still only a month old, 16 states are already considering legislation to do so. The desire to act on prior authorization comes as providers continue to express dismay over delays in insurer review of the courses of treatment they seek to initiate for their patients, with some providers maintaining that those delays are jeopardizing the well-being of those patients. Insurers, meanwhile, insist that their reviews are necessary to ensure the health of their patients. In response to such expressed [...]

iqtsupport2023-01-30T06:00:53-05:00January 30, 2023|Uncategorized|

Health Insurance Markets Remain Highly Concentrated

The health insurance market was highly concentrated in 42 of the 50 states in 2019 and 2020 – the continuation of a trend identified in 2010 that has persisted ever since, according to a new report by the U.S. Government Accountability Office. The GAO considers a market concentrated if three or fewer insurers in a state have 80 percent of that market. Using Centers for Medicare & Medicaid Services health insurance enrollment data, the GAO looked at three distinct aspects of markets – individual policies, small group policies, and large group coverage – and found that Each of the three [...]

iqtsupport2022-11-10T06:00:51-05:00November 10, 2022|Affordable Care Act, Uncategorized|