About one in five in-network claims were denied by insurers of qualified health plans on HealthCare.gov in 2023, according to KFF. There is also wide variation by insurer and state. The post Report: HealthCare.gov Insurers Denied 19% of In-Network Claims in 2023 appeared first on MedCity News.
Major federal changes to Medicaid and other health-related policies could impact children’s health in the coming years. This issue brief explores the latest data on Medicaid and children’s health and highlights five key issues to watch as those federal changes are implemented.
Gaps in reimbursement oversight and recovery will only widen, unless plans modernize how they detect, investigate, and recoup improper payments. The post Modernizing Payment Integrity in an Era of Systemic Fraud appeared first on MedCity News.
This near-constant level of unpredictability forces us to ask a tricky question: how can biopharma companies stay ahead? The answer, as to many of the tricky questions of our time, lies in having a clear and authentic mission to act as a guiding lighthouse in the turbulent waters of change. The post Maintaining Composure in…
In the two counties around nurse practitioner Samantha Marsee’s clinic in rural northeastern Maryland, there’s not a single clinic that provides abortions. And until recently, Marsee herself wasn’t trained to treat patients who wanted to end a pregnancy. “I didn’t really have a lot of knowledge about abortion care,” she said. After Roe v. Wade…
“I’d like to see Generalized Cost Effectiveness Analysis become the norm for how we assess value.” – Rep. Jake Auchincloss (D-MA 4th District) See the full interview here. To learn more about GCEA, check out the GCEA User Guide published last year.
Withings exec Patrick Sheehan and MedStar’s Ethan Booker, M.D., talk about why concierge medicine is sometimes at the center of digital innovation
The next era of health won’t be defined by how big our hospitals are. It will be defined by how fast – and how fairly – we deliver care. The post We’ve Taught Machines To Save Lives — Now We Need To Let Them appeared first on MedCity News.
To better understand the growing role of Special Needs Plans (SNPs) in Medicare Advantage, this brief examines SNP enrollment trends using recent Medicare Advantage enrollment data published by the Centers for Medicare and Medicaid Services (CMS).
Is $50 billion over five years enough to end the rural healthcare crisis or even offset the federal spending cuts? No – but it’s what states have to work with. And the pressure is on them to maximize the impact of their RHTP grants. Here’s how they can do it. The post How States Can…