HEALTHCARE NEWS

New Communication Center in Availity Essentials, Aetna  Streamlining Credentialing Communication for Healthcare Providers Aetna's recent announcement about the addition of a new Communication Center in Availity Essentials marks a significant step forward in provider enrollment and net...

The Debate Over Medicaid Work Requirements  Medicaid, a cornerstone of the American healthcare system, has long served as a safety net for low-income individuals and families. However, with rising enrollment and increasing federal expenditures, policymakers have continuously debated how to...

Claims Denials and Appeals in ACA Marketplace Plans  The Affordable Care Act (ACA) has significantly reshaped the U.S. healthcare landscape, improving access to coverage for millions of Americans. However, claims denials remain a persistent challenge for both patients and providers. Accord...

Preparing for 2024 MIPS Data Submission  As the calendar turns to 2025, the focus for providers shifts to the critical task of submitting Merit-based Incentive Payment System (MIPS) data for the 2024 performance year. This process is essential for clinicians participating in the Quality Pa...

The Centers for Medicare & Medicaid Services (CMS) recently released the 2025 CMS Quality Reporting Document Architecture (QRDA) Category III Implementation Guide (IG), Schematron, and Sample Files for Eligible Clinician Programs. These updates align with the Calendar Year (CY) 2025 Medicare Phy...

Navigating the Intricacies of Direct Access for Physical Therapy  Physical therapists are no exception when it comes to navigating regulatory changes that affect patient care and insurance reimbursements. Since November 23, 2006, New York State has allowed physical therapists with at least...

Medicare Physician Fee Schedule Final Rule CY 2025 (Healthcare News)  The Centers for Medicare & Medicaid Services (CMS) has issued its final rule for the Medicare Physician Fee Schedule (PFS) for Calendar Year 2025, detailing crucial updates for payment policies and Medicare reimburse...

The ACA Premium Subsidies: What’s at Stake in 2025?   As the United States prepares for a potential change in administration in 2025, the future of the Affordable Care Act (ACA) premium subsidies hangs in the balance. Originally expanded during the COVID-19 pandemic under the Am...

The Centers for Medicare & Medicaid Services (CMS) recently released the finalized Calendar Year (CY) 2025 Medicare Physician Fee Schedule (PFS) Rule, which outlines crucial updates and policy shifts for the Quality Payment Program (QPP) beginning with the 2025 performance year. Set to be publis...

Providers are no strangers to the burden of prior authorization, a process requiring physicians to submit detailed paperwork to insurers for approval before administering treatments. Insurers claim this process helps prevent unnecessary medical interventions, saving the healthcare system from wastef...

ICD-10-CM updates don’t often get much fanfare, but this year brings a notable shift for rehab therapists, especially those treating musculoskeletal issues. The longstanding challenges of coding for conditions like lumbar disc degeneration or synovitis—previously hindered by vague, unspe...

While the U.S. has made strides in reducing uninsurance rates, access to quality healthcare remains a complex challenge. We decided to explore the systemic barriers that hinder access to care, the crucial role of research in addressing these issues, and the potential of emerging trends to improve he...

To simplify the healthcare experience and reduce the administrative burden on healthcare providers, UnitedHealthcare is introducing a groundbreaking initiative: the National Gold Card program. Set to officially launch on October 1, 2024, this program represents a major step forward in modernizing th...

Healthcare organizations have increasingly focused on addressing social determinants of health (SDOH) to improve patient outcomes and reduce healthcare costs. SDOH refers to non-medical factors like income, education, environment, employment, and social networks that heavily influence a person’...

On August 16, 2024, Humana Inc. agreed to a $90 million settlement after a whistleblower lawsuit claimed the company overcharged Medicare for prescription drugs. Filed by former Humana actuary Steven Scott, the lawsuit exposed major issues within Medicare Part D and highlighted important takeaways f...