Healthcare Dive

JANUARY 24, 2024

The health insurer’s stock plunged Thursday morning following its 2023 results, which fell startlingly short of Wall Street’s expectations.

Medicare 274

Medicare Medicare Health Insurance 274

MRO Compliance

MAY 15, 2025

Overview of Major Health Plan Types Medicare: A federal program for individuals 65+ or those under 65 with disabilities, offering coverage for facility, outpatient, and prescription drug services. Medicare and Medicaid can work together for dual-eligible beneficiaries, offering comprehensive support.

Electronic Medical Records 147

Electronic Medical Records Medicaid Medicaid ACA 147

Medisys Compliance

MARCH 31, 2025

Introduction For many physician practices, Medicare beneficiaries represent a significant portion of their patient population. However, navigating the complexities of Medicare billing can be a challenging task, especially when considering its distinct differences from private insurance models.

Medicare 59

Medicare Medicare Medical Billing Medical Billing Outsourcing 59

HIT Consultant

APRIL 9, 2025

What You Should Know: – Health insurance members, both in commercial and Medicare Advantage plans, are increasingly relying on their health plan’s websites and mobile apps for communication. Commercial member health plans: Average app satisfaction is 653 (on a 1,000-point scale). – The J.D.

Health Insurance 52

Health Insurance Medicare Medicare 52

Bill of Health

OCTOBER 17, 2024

Finally, SB 1120 limits the degree to which health insurers can use AI to determine medical necessity for member health care services. SB 1223 amended the California Consumer Privacy Act of 2018 to include neural data as sensitive personal information, whose collection and use companies can be directed to limit.

Medicare 150

Medicare Medicare Health Insurance Licensing 150

Healthcare Dive

JANUARY 24, 2024

The head of the Senate Finance Committee sent letters to several health insurance exchanges on Tuesday, as part of an inquiry into allegedly predatory Medicare Advantage marketing to seniors.

Health Insurance 261

Health Insurance Medicare Medicare 261

Fierce Healthcare

AUGUST 27, 2024

A decade ago, federal officials drafted a plan to discourage Medicare Advantage health insurers from overcharging the government by billions of dollars—only to abruptly back off amid an “uproar” fr | Filings and testimonies in a multibillion-dollar Justice Department civil fraud case against UnitedHealth Group outline industry pressure that led the (..)

Medicare 132

Medicare Medicare Fraud Governance 132

Fierce Healthcare

SEPTEMBER 30, 2024

As the calendar turns to October, the health insurance industry is gearing up for Medicare's annual enrollment period. | As the calendar turns to October, the health insurance industry is gearing up for Medicare's annual enrollment period.

Medicare 128

Medicare Medicare Health Insurance 128

Fierce Healthcare

OCTOBER 15, 2024

CareNu is starting to sign members up for health insurance through its Medicare Advantage plan for the first time. CareNu's subsidiary is launching an Institutional Special Needs Medicare Advantage plan in Florida for patients with chronic illness.

Medicare 123

Medicare Medicare Health Insurance 123

Healthcare Dive

AUGUST 8, 2023

UnitedHealth, CVS, Elevance and peers sidestepped the worst of medical cost growth in the quarter, but many payers face uncertainty from Medicare Advantage star ratings, GLP-1s and other pressures.

Health Insurance 130

Health Insurance Medicare Medicare 130

Center for Health Insurance Reform

MARCH 31, 2023

The Affordable Care Act (ACA) recently celebrated its 13th anniversary with historic enrollment growth in the health insurance Marketplaces and the lowest-ever recorded uninsured rate.

Health Insurance 97

Health Insurance ACA Medicaid Medicaid 97

HIPAA Journal

MAY 1, 2025

More than 450,000 individuals had their information exposed in the incident. Several lawsuits were filed in response to the breach against Somnia, Anesthesia Services of San Joaquin, Palm Springs Anesthesia Services, Resource Anesthesiology Associates of IL, Resource Anesthesiology Association of NM, and Anesthesia Associates of El Paso.

HIPAA 109

HIPAA Fraud Licensing Health Insurance 109

HIT Consultant

NOVEMBER 8, 2021

Jessica Altman, Pennsylvania’s insurance commissioner sums it up well : “When we talk about bringing something back to state control, that is a real narrative that can appeal to both sides of the aisle. There is nothing political about making health insurance more affordable.”.

Health Insurance 98

Health Insurance Medicaid Medicaid Governance 98

Electronic Health Reporter

APRIL 27, 2023

This article is copyrighted strictly for Electronic Health Reporter. Medicare is a federal health insurance program in the United States that provides coverage to people 65 or older and some younger people with specific disabilities. Illegal copying is prohibited. appeared first on electronichealthreporter.com.

Medicare 103

Medicare Medicare Health Insurance 103

HIT Consultant

AUGUST 26, 2022

What You Should Know: – Digital senior care navigator Fair Square Medicare raises 15M in series A funding led by Define Ventures. Launched in 2020 out of YC, Fair Square Medicare is a digital health platform company that’s revolutionizing how seniors navigate their healthcare. Care Navigator for Seniors.

Medicare 97

Medicare Medicare Health Insurance 97

Bill of Health

JUNE 15, 2023

By Laura Dolbow Merck recently filed a lawsuit that challenges the constitutionality of the Medicare price negotiation program created by the Inflation Reduction Act. Merck argues that this form of price regulation charts a “ radical new course ” for Medicare that violates the Takings Clause of the Fifth Amendment.

Medicare 195

Medicare Medicare Medicaid Medicaid 195

Bill of Health

JANUARY 26, 2022

In other words, both convicted individuals and those still presumed innocent are stripped of their access to the federal health insurance program for low-income individuals. Gamble (1976), affirmed that incarcerated individuals have the constitutional right to health care. The Supreme Court’s ruling in Estelle v.

Medicaid 299

Medicaid Medicaid COVID-19 Public Health 299

HIPAA Journal

NOVEMBER 21, 2022

million being defrauded from Medicaid, Medicare, and private health insurance programs. Five state Medicaid programs, two Medicare Administrative Contractors, and two private health insurers were tricked into changing the bank account details for payments. million, and $6.4

Medicaid 102

Medicaid Medicaid Medicare Medicare 102

Healthcare IT News - Telehealth

OCTOBER 21, 2020

Data released this past week from the Centers for Medicare and Medicaid Services show that more than 34.5 million services were delivered via telehealth in Medicare and in the Children's Health Insurance Program from March through June.

Medicaid 214

Medicaid Medicaid Medicare Medicare 214

Modern Healthcare

MARCH 31, 2023

The Centers for Medicare and Medicaid Services estimates health insurance companies will see a 3.32% increase in Medicare Advantage revenue next year.

Medicare 84

Medicare Medicare Health Insurance Medicaid 84

Health Populi

JUNE 5, 2022

Fast-forward through the 1990s and the advent of PBMs — pharmacy benefit management companies — the intermediaries managing drug benefits for health insurance plans. Today, the three largest PBMs, processing about 4 in 5 retail prescription claims, are embedded in large health insurance companies.

Overpayments 154

Overpayments Overpayment Medicare Medicare 154

HIPAA Journal

MARCH 28, 2025

The account was reviewed, and on January 24, 2025, it was confirmed that emails in the account contained the protected health information of patients of Beacon Health Systems Three Rivers Health Hospital in Michigan. Restorix sent notification letters to the affected patients on December 18, 2024.

Licensing 72

Licensing Health Insurance HIPAA Medicaid 72

Fierce Healthcare

AUGUST 12, 2024

A recent rule by the Centers for Medicare & Medicaid Services (CMS) extending health insurance to children of undocumented immigrants under the Deferred Action for Childhood Arrivals (DACA) pro | A coalition of right-leaning states are calling foul on a recent CMS rule that would expand health insurance for DACA recipients under the Affordable (..)

Health Insurance 124

Health Insurance Medicaid Medicaid Medicare 124

Health Populi

JUNE 18, 2021

with employer-sponsored health insurance worry that a major health event in their household could lead to bankruptcy, according to research gathered by West Health and Gallup in Business Speaks: The Future of Employer-Sponsored Insurance. Health Populi’s Hot Points: U.S. One-half of U.S.

ACA 139

ACA Health Insurance Medicaid Medicaid 139

Healthcare Dive

MAY 14, 2024

At that time, current chief operating officer Jim Rechtin will take the reins of the health insurer, which is struggling with challenges in Medicare Advantage.

Health Insurance 130

Health Insurance Medicare Medicare 130

Healthcare IT News - Telehealth

MARCH 25, 2021

Researchers limited the study population to individuals covered through employer-based, Affordable Care Act and other private health insurance plans, but not Medicare or Medicaid – an important limitation, given emerging evidence about virtual care's role in exacerbating the digital divide.

COVID-19 218

COVID-19 Public Health Medicare Medicare 218

Healthcare It News

DECEMBER 16, 2022

For those with chronic and mental health conditions covered by Medicaid and the State Children's Health Insurance Program, reimbursement for digital platforms and applications that can improve health outcomes has been limited. The bipartisan bill, S.5238,

Medicaid 258

Medicaid Medicaid COVID-19 Health Outcomes 258

Healthcare IT Today

OCTOBER 19, 2024

John summarized a study in the American Journal of Managed Care highlighting how real-time interventional analytics reduced 30-day readmissions and Medicare spending per beneficiary for Penn Medicine affiliates. Read more… Funding and M&A Activity: Health insurance verification vendor Nirvana raised $24.2

Health Insurance 90

Health Insurance Medicare Medicare Hospitals 90

HIT Consultant

NOVEMBER 7, 2022

It provides a mark of distinction for healthcare and demonstrates the company’s commitment to quality, which means improved patient health outcomes.

Health Insurance 98

Health Insurance Compliance Officers Health Outcomes Medicare 98

Kaiser Health News

NOVEMBER 11, 2021

Finding the best private Medicare drug or medical insurance plan among dozens of choices is tough enough without throwing misleading sales tactics into the mix. The problems are especially prevalent during Medicare’s open-enrollment period, which began Oct. “You’re not from Medicare,” Heimer told her.

Medicare 144

Medicare Medicare Doctors Fraud 144

Center for Health Insurance Reform

FEBRUARY 10, 2022

Continue reading → The post January Research Roundup: What We’re Reading appeared first on Center on Health Insurance Reforms.

Health Insurance 98

Health Insurance Medicare Medicare ACA 98

Center for Health Insurance Reform

NOVEMBER 18, 2024

Last month we read about health system competition in metropolitan areas, health care affordability prior to the American Rescue Plan (ARPA,) how high deductible health insurance can exacerbate racial and ethnic wealth disparities, and about unmet dental vision and hearing needs among low-income Medicare Advantage beneficiaries.

Health Insurance 52

Health Insurance Medicare Medicare 52

Bill of Health

MARCH 27, 2024

Billing medical insurance for Spravato involves codes for both drug delivery and supervision because treatment requires administration of the drug (using the intranasal spray) and a monitoring period of at least 2 hours at a certified treatment center. Spravato is covered by Medicare Part B , which pays 80% of expenses.

FDA 203

FDA Medicare Medicare Health Insurance 203

Fierce Healthcare

DECEMBER 20, 2023

Among our most-read stories of the year, one topic clearly rose to the top: Medicare Advantage. Many of the most-read health insurance stories from Fierce Healthcare in 2023 center on Medicare Advantage.

Medicare 114

Medicare Medicare Health Insurance 114

Center for Health Insurance Reform

DECEMBER 4, 2024

In 2023, for the first time, more than half of Medicare beneficiaries were enrolled in Medicare Advantage (MA) plans, which offer private insurance alternatives to traditional Medicare, with 34 million enrollees in MA and 23 million in standalone Part D drug plans.

Medicare 52

Medicare Medicare Health Insurance 52

HIT Consultant

APRIL 10, 2024

Power reveals significant shortcomings in the digital experiences offered by health insurance providers in the United States. Healthcare Digital Experience Study found that a surprising 42% of insured adults have encountered problems using their health insurance company’s website or app in the past year.

Health Insurance 59

Health Insurance Medicare Medicare Hospitals 59

Healthcare It News

FEBRUARY 28, 2023

The payer mix of health insurance is typical, with 35% of patients representing government insurance such as Medicare or Medicaid, 60% commercial insurance, and 6% self-pay patients. The majority of patients using the virtual-first clinic are females (70%), and the average age range has been 40-50.

Electronic Medical Records 305

Electronic Medical Records Telemedicine COVID-19 Health Insurance 305