October 24, 2025
Nona Tepper
Elevance Health has notified healthcare facilities they face penalties for assigning out-of-network clinicians to its members.
Starting Jan. 1, hospitals and other inpatient and outpatient facilities must ensure that all providers involved in care for members of Elevance Health’s Anthem Blue Cross Blue Shield commercial plans in 11 states are under contract with the insurer, Anthem said in a notice.
Facilities that don’t comply may be assessed administrative penalties equivalent to 10% of the allowed amounts payable under the claims in question, and may be terminated from Anthem networks. Facilities are not permitted to pass the cost of administrative penalties on to patients.
October 23, 2025
By Nona Tepper
Major health insurance companies are expanding where they sell exchange plans for 2026 despite uncertainty over rising costs and federal policy.
The biggest unknown is how Congress will deal with the enhanced exchange subsides that drove record enrollment in recent years but are scheduled to expire at the end of 2025. The issue is at the center of the showdown between the Republican congressional majority and the Democratic minority that led to the government shutdown that began Oct. 1.
Still, most exchange carriers are entering new states and counties for the 2026 plan year. The open enrollment period spans Nov. 1-Jan. 15 in most states.
October 15, 2025
Jeffrey Young
Medicare will hold claims for telehealth and hospital-at-home services while Congress is at an impasse over funding the government and renewing key healthcare programs, the agency said in a notice Wednesday.
The legal authorities for fee-for-service Medicare to cover telehealth and hospital-at-home care expired Oct. 1. CMS has instructed Medicare billing contractors to hold claims for services performed on or after that date, the agency said in the notice.
Congress failed to extend these programs amid the stalemate over fiscal 2026 government spending, which led to a shutdown that began Oct. 1.
August 26, 2025
Alex Kacik
Concierge and direct primary care practices are gaining traction among physicians, employers and patients increasingly frustrated with traditional care pathways.
The growth of these practices, where patients pay membership fees in exchange for increased access to physicians, is a symptom of Medicare and Medicaid reimbursement that has not kept pace with inflation, advisers, doctors and policy experts said. Growing care backlogs, coding and documentation tasks that take doctors away from patients and seemingly ever-rising health insurance premiums are also contributing, they said.
September 11, 2025
Lauren Dubinsky
Hospitals could see another popular procedure move to ambulatory surgery centers if it is reimbursed by the Centers for Medicare and Medicaid Services.
Cardiac ablations are among a larger group of procedures CMS is considering adding to the list of procedures they would cover at ASCs and industry groups have advocated for their inclusion for years. Currently, the agency only reimburses the procedures in hospital and hospital outpatient settings.
September 10, 2025
Caroline Hudson
Kaiser Permanente and Renown Health signed an agreement to form a joint venture to operate a health plan and ambulatory care services in Nevada.
As part of the deal, Kaiser would acquire a majority stake in Renown’s insurance arm, Hometown Health, which has more than 73,000 members. Kaiser plans to start offering health plan coverage in northern Nevada as Kaiser Permanente Nevada with an open enrollment period late next year, according to a Wednesday news release.
August 04, 2025
Caroline Hudson
Private equity deals in healthcare this year may not be on the downward spiral investors initially feared, according to a PitchBook report released Tuesday.
“The ‘sluggish start’ to PE healthcare services dealmaking that we noted in our Q1 update has evolved into slow but steady activity — below last year’s levels but far from a collapse,” the report said.
PitchBook estimates 322 healthcare services deals closed in the first half of 2025, compared with 339 deals in the first half of 2024.
July 14, 2025
Bridget Early
The base Medicare rate for doctors would rise 2.5% in 2026 under a proposed rule the Centers for Medicare and Medicaid Services published Monday.
President Donald Trump and Congress mandated this one-year boost to physician reimbursement in the tax bill that became law this month. That same statute offers a higher increase for doctors participating in alternative payment models.
CMS proposed Medicare reimbursement cuts the previous five years. Congress intervened to forestall them in most cases, but not this year, when doctors saw a 2.9% reduction.
July 01, 2025
Caroline Hudson
The Senate brought the One Big Beautiful Bill Act of 2025 and its more than $1 trillion in cuts to Medicaid and other healthcare programs one critical step closer to President Donald Trump’s desk Tuesday.
Healthcare organizations have sharply criticized the legislation since Trump and the Republican majority in Congress began working on the measure in January. Following the Senate action, trade associations slammed the bill, saying it would devastate providers and patients.
June 23, 2025
Nona Tepper
Bridget Early
UnitedHealth Group, Elevance Health, Aetna, Cigna and more than 40 other health insurance companies on Monday jointly announced an initiative to streamline prior authorizations.
Under the auspices of leading industry groups AHIP and the Blue Cross Blue Shield Association, the coalition of for-profit and nonprofit insurers pledged to reduce what providers characterize as the ever-increasing burden of obtaining precertifications for care.