May 24, 2023
CAROLINE HUDSON
Hospitals and health systems hope for a resolution to the federal government’s debt ceiling standoff, warning that a failure to reach an agreement could have a catastrophic impact on provider payments.
Republicans and Democrats continue to haggle over a deal to raise the $31.4 trillion national debt limit and keep the U.S. from defaulting on its agreements, potentially in early June.
May 02, 2023
NONA TEPPER
Envision Healthcare has notched a win in its ongoing out-of-network reimbursement dispute against UnitedHealth Group, the physician staffing company announced Tuesday.
April 20, 2023
AMELIA ICKES
Anthem Blue Cross has issued a systemwide notice amending its physician agreement to require contracted physicians to maintain privileges with at least one in-network ambulatory surgery center.
March 20, 2023
CAROLINE HUDSON
Insurance companies are ramping up efforts to recover overpayments made to hospitals and health systems—adding to providers’ operational and financial challenges in an already-tough economic environment.
In a practice known as clawbacks, insurers can recoup money after determining they’ve paid too much on past claims due to incorrect coding or fee-for-service reclassifications. Some enlist third-party companies to find overpayments, even if they occurred years ago. Insurance companies typically offset the amount owed by deducting it from the current plan account, meaning they pay less for other services.
March 13, 2023
GABRIEL PERNA
Venture capital firms and founders of digital health companies are picking up the pieces after an eventful few days tied to the failure of Silicon Valley Bank.
“We had all of our money at Silicon Valley Bank. They were our full banking partners,” said Ellen DaSilva, CEO and founder of Summer Health, a text-based pediatric care provider. “When I started the company, I would say all of the people in my life also banked with SVB.”
March 10, 2023
BROCK E.W. TURNER
The Federal Deposit Insurance Corporation’s decision to take over Silicon Valley Bank on Friday is likely to leave many digital health companies scrambling to pay employees and suppliers.
SVB, the nation’s16th largest bank and headquartered in Santa Clara, California, was a big bank for tech companies, startups and venture capital firms. The bank said on its website that it had $78.8 billion in healthcare deposits and investments as of December.
03/10/2023
Riz Hatton
Many physicians have expressed dissatisfaction with their income in light of inflation and CMS pay cuts. However, some specialties have seen a sharper drop in pay than others.
This data was pulled from Physicians Thrive’s 2022 Physician Compensation Report and Merritt Hawkins and AMN Healthcare’s 2022 “Review of Physician and Advanced Practitioner Recruiting Incentives” reports.
February 23, 2023
NONA TEPPER
Humana will leave the commercial health insurance market and focus its efforts on government-sponsored products such as Medicare Advantage, the company announced Thursday.
February 06, 2023
GABRIEL PERNA
The coming end of the COVID-19 public health emergency and pandemic-era telehealth flexibilities could rattle an already besieged behavioral health system and force providers to make ethical decisions.
The public health emergency, which President Biden will end May 11, allowed clinicians to prescribe controlled substance medications via telehealth without an office visit. The 2008 Ryan Haight Act, which temporarily waived the office visit requirement, allowed providers to treat a larger population of behavioral health patients more efficiently because they could prescribe and see patients remotely.
January 30, 2023
LAUREN BERRYMAN
Medicare Advantage carriers will be on the hook for errors made in diagnostic coding reaching back to 2018 under a final rule the Centers for Medicare and Medicaid Services issued Monday.
The Medicare Risk Adjustment Data Validation, or RADV, regulation took five years to complete after its draft version published in 2018 and attracted vehement opposition from the health insurance industry.
