Month: November 2023

November 21, 2023

LAUREN BERRYMAN   
BROCK E.W. TURNER 

The alleged use of artificial intelligence for prior authorization and claim denials has led to lawsuits against two major health insurance companies.

UnitedHealth Group and Cigna have been separately accused of allegedly using automated tools to deny some claims, which plaintiffs say reduces the insurers’ labor costs. Both policymakers and physician leaders are asking insurance companies to open up their AI playbooks in response to these allegations.

November 02, 2023

ALISON BENNETT 

Physicians will be hit with a 1.25% reduction in Medicare reimbursements next year under a final rule the Centers for Medicare and Medicaid Services issued Thursday.

The American Medical Association and other doctor groups sharply criticized the proposed rule CMS published in July, which contained the same pay cut, and have taken their case to Congress that Medicare fees for physicians should not be reduced.

11/02/23

ALEX KACIK  
ALISON BENNETT  

Providers participating in the 340B drug discount program will receive approximately $9 billion to compensate them for reductions in previous years under a final rule the Health and Human Services Department and the Centers for Medicare and Medicaid Services published Thursday.

CMS will distribute the money in lump sums to eligible providers to undo reimbursement cuts from 2018 to 2022, which the Supreme Court ruled invalid last year. About 1,700 hospitals are due to receive funds by Jan. 1. But because federal law requires this spending to be budget-neutral, CMS offset the cost by reducing reimbursements for other outpatient products and services by $7.8 billion.