Commercial Insurer Accountability

Health insurers have gone through dramatic vertical consolidation since ERISA was signed into law. Over the last decade, the major corporate insurers have spent billions of dollars acquiring not only other plans, but also providers, pharmacy service companies, and health technology and claims…
People enrolled in Medicare Advantage are more likely than those in traditional Medicare to report delays in care due to needed insurance approvals, according to a survey released Feb. 22 by the Commonwealth Fund, with 13% of traditional Medicare enrollees reporting associated delays compared with…
The CMS Feb. 6 released a Frequently Asked Questions document pursuant to the calendar year 2024 Medicare Advantage final rule, which went into effect Jan. 1.
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Andrea Preisler, AHA’s senior associate director of administrative simplification policy, explains why the recent final rule requiring Medicare Advantage, Medicaid and federally facilitated Marketplace plans to streamline their prior authorization processes should help reduce the burden on…
The Centers for Medicare & Medicaid Services (CMS) Jan. 17 finalized new regulations aimed at reforming the prior authorization process.
In this memo, the CMS provides clarification about how MA plans should comply with the 2024 Medicare Advantage rule.
Chris Barber, president and CEO of St. Bernards Healthcare, discusses the problems certain MA plan practices can create for patients and their caregivers, especially for rural hospitals and health systems that face a unique set of challenges in caring for their communities.