Healthcare Highlights: Navigating Challenges and Changes - August 2024
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This month, we focus on the latest updates and actions surrounding the No Surprises Act (NSA).
Read on to learn how we're working to protect consumers from unexpected medical costs and ensure compliance across the healthcare sector.
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Radiologists have been particularly successful in resolving surprise billing disputes under the No Surprises Act.
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The median offers radiologists secure are approximately 500% higher than the qualifying payment amount. This success demonstrates radiologists' strong position in arbitration cases related to surprise billing.
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In 2023, four private equity-owned organizations were involved in about 70% of arbitration cases under the No Surprises Act.
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These organizations collectively accounted for a significant portion of the 657,040 arbitration cases filed against insurers. The data indicates substantial industry activity in dispute resolution involving these private equity firms.
- • Disputed Bill Locations:
- • Half of the arbitration cases were from Texas, Florida, Tennessee, and Georgia.
- • States like Connecticut, Maryland, Massachusetts, and Washington had significantly fewer cases.
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UnitedHealth Group: $4.2 billion, 2. Elevance Health: $2.3 billion, 3. CVS Health: $1.8 billion, 4. Cigna Group: $1.5 billion, 5. Centene: $1.1 billion, 6.
Humana: $679 million
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Carson Tahoe Health has ended its contract with UnitedHealthcare. This decision could affect up to 13,000 people by May 2025.
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The termination was due to concerns over care delays and administrative issues, but discussions between the two parties are still ongoing.
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Medicare Advantage insurers submitted over 46 million prior authorization requests in 2022, up from 37 million in 2019.
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The surge in requests has sparked worries about the increased burden on healthcare providers and patients. The significant rise in prior authorizations highlights the expanding administrative demands within Medicare Advantage.
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Health system-payer negotiations are reaching a critical point. The outcome of these negotiations could significantly affect healthcare delivery.
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The phrase suggests growing tensions and the need for resolution between health systems and payers.
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The court upheld a challenge against parts of the federal surprise billing rule, agreeing that the rule unfairly favoured insurers by prioritizing the Qualifying Payment Amount (QPA), and affirmed that some provisions exceeded statutory authority and violated the Administrative Procedure Act.
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The ruling has attracted considerable attention from the healthcare industry, with major lobbying groups and organizations expressing widespread concern through amicus briefs.
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Carson Tahoe Health plans to terminate its contract with UnitedHealthcare by May 2025, potentially impacting up to 13,000 patients, including state workers. The decision stems from concerns over care delays, administrative hurdles, and financial strain, particularly related to Medicare Advantage.
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Despite over a year’s notice and ongoing talks, Carson Tahoe Health has faced difficulties in reaching a new agreement with UnitedHealthcare. The health system remains hopeful that the remaining contract time will allow for a resolution.
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