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Skyrocketing Hospital Administrative Costs, Burdensome Commercial Insurer Policies Impacting Patient Care
Between 2022 and 2023, care denials increased an average of 20.2% and 55.7% for commercial and Medicare Advantage (MA) claims, respectively.
Payer Denial Tactics — How to Confront a $20 Billion Problem
The high cost to health care providers to obtain reimbursement from insurers shows no signs of abating. A recent report from the group purchasing and consulting organization Premier highlights the long-standing problem.
CY2024 Medicare Advantage Final Rule Implementation Handbook
On April 5, the Centers for Medicare & Medicaid Services (CMS) finalized its Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Program for contract year (CY) 2024. The final rule increases oversight of Medicare Advantage (MA) plans and seeks to better align MA coverage with Traditional Medicare.
CMS FAQs on 2024 Medicare Advantage Rule
In this memo, the CMS provides clarification about how MA plans should comply with the 2024 Medicare Advantage rule.
New Consumer Poll Finds Patients Are Concerned about Commercial Insurer Barriers to Care: Infographic
Commercial health insurer policies and administrative practices delay patient care, overburden clinicians and add unnecessary costs to the health care system, according to a new poll of health care consumers conducted by the Morning Consult.
Will a Chatbot Be Just What the Doctor Ordered for Reimbursement Appeals?
The Doximity digital platform for medical professionals has launched a beta version of ChatGPT to help streamline time-sapping administrative tasks like drafting and faxing preauthorizations and appeals letters to insurers.
Addressing Commercial Health Plan Challenges to Ensure Fair Coverage for Patients and Providers
This report documents the American Hospital Association’s (AHA) findings related specifically to prior authorization and payment delays and denials. This work is informed by two large surveys of hospitals, as well as interviews and group discussions with hundreds of hospital and health system leaders.
Survey: Commercial Health Insurance Practices that Delay Care, Increase Costs Infographic
Certain commercial health insurer policies and administrative practices delay patient care, overburden clinicians and withhold critical payments from providers.
Commercial Health Plans’ Policies Compromise Patient Safety and Raise Costs
The cost of commercial insurance is increasing at an unsustainable rate — squeezing individuals and families, employers, and public programs. The average family insurance premium has increased 47% over the past 11 years — faster than general inflation and more than any other part of the health care system.i
New Solution Helps to Address Unfair Commercial Health Care Plans
To help members reduce the significant operational challenges caused by some of these commercial payer issues, the AHA has also launched a new solution, the AHA Vitality Index.