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CMS HAS REOPENED THE NO SURPRISES ACT IDR PORTAL FOR ALL DISPUTES

On December 15, 2023, CMS reopened its IDR portal to process all dispute types and granted extensions to certain deadlines.  Specifically, CMS announced: For disputing parties engaged in IDR entity selection for batched disputes when the IDR portal temporarily closed, the deadline for selecting a certified IDR entity is December 29, 2023. Disputing parties with …

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PATIENTS FILE LAWSUITS AGAINST HUMANA AND UNITED’S MEDICARE ADVANTAGE PLANS FOR DENYING CARE BASED ON AI ALGORITHMS

Patients with Humana’s Medicare Advantage plan have recently filed a class action suit in federal court for the Western District of Kentucky alleging that Humana “systematically denies” medically necessary rehabilitation care based on an algorithm using artificial intelligence. The lawsuit alleges that Humana used naviHealth’s nh Predict platform to make coverage determinations for long-term rehabilitation …

PATIENTS FILE LAWSUITS AGAINST HUMANA AND UNITED’S MEDICARE ADVANTAGE PLANS FOR DENYING CARE BASED ON AI ALGORITHMS Read More »

PATIENT GROUPS SEEK URGENT ACTION FROM CMS AND THE FTC TO ADDRESS UNITED’S ALLEGEDLY DECEPTIVE MEDICARE ADVANTAGE MARKETING

In a strongly worded letter to the Centers for Medicare & Medicaid Services and the Federal Trade Commission, four patient advocacy groups are seeking urgent action to address UnitedHealthcare’s “misleading advertising” directed at low-income Connecticut residents who are dually eligible for Medicare and Medicaid.  The letter alleges that the advertisements “fraudulently induce these vulnerable individuals” …

PATIENT GROUPS SEEK URGENT ACTION FROM CMS AND THE FTC TO ADDRESS UNITED’S ALLEGEDLY DECEPTIVE MEDICARE ADVANTAGE MARKETING Read More »

THE AHA AND FAH URGE CMS TO ENFORECE NEW MEDICARE ADVANTAGE RULES IN LIGHT OF RECENT MA PLAN POLICIES THAT AHA AND FAH BELIEVE VIOLATE THE RULES

In strongly worded letters, the American Hospital Association (AHA) and the Federation of American Hospitals (FAH) ask the Centers for Medicare & Medicaid Services (CMS) “to conduct rigorous oversight” and to enforce its new rules governing Medicare Advantage (MA) plans in light of recently adopted MA plan policies that AHA and FAH believe violate the …

THE AHA AND FAH URGE CMS TO ENFORECE NEW MEDICARE ADVANTAGE RULES IN LIGHT OF RECENT MA PLAN POLICIES THAT AHA AND FAH BELIEVE VIOLATE THE RULES Read More »

WASHINGTON POST ARTICLE HEADLINED “HOSPITALS AND DOCTORS ARE FED UP WITH MEDICARE ADVANTAGE” REFLECTS THE EXPERIENCE OF WHATLEY KALLAS’S PROVIDER CLIENTS

The Washington Post has published an article headlined “Hospitals and Doctors are Fed Up with Medicare Advantage,” which reports on increasing provider complaints with Medicare Advantage plans’ claim denials and onerous preapproval requirements. The article quotes Chip Kahn, the president and CEO of the Federation of American Hospitals as saying:  “The insurance companies running the …

WASHINGTON POST ARTICLE HEADLINED “HOSPITALS AND DOCTORS ARE FED UP WITH MEDICARE ADVANTAGE” REFLECTS THE EXPERIENCE OF WHATLEY KALLAS’S PROVIDER CLIENTS Read More »

NASCO ANNOUNCES DATA BREACH AFFECTING OVER 800,000 BLUE CROSS AND BLUE SHIELD OF MASSACHUSETTS PATIENTS

Patient data has been exposed in a recently announced security breach impacting over 800,000 patients, including members of Blue Cross and Blue Shield of Massachusetts (BCBSMA).  This breach included full names, email addresses, physical addresses, and telephone numbers. Social Security numbers (SSNs), health insurance and medical ID numbers, dates of service, treatment and diagnostic codes, …

NASCO ANNOUNCES DATA BREACH AFFECTING OVER 800,000 BLUE CROSS AND BLUE SHIELD OF MASSACHUSETTS PATIENTS Read More »

WELLTOK ANNOUNCES DATA BREACH AFFECTING HEALTH PLANS, INCLUDING SOME BLUE CROSS AND BLUE SHIELD PLANS

Patient data has been exposed in a recently announced security breach impacting almost 8.5 million patients, including members of several Blue Cross and Blue Shield health plans.  This breach included full names, email addresses, physical addresses, and telephone numbers. For some, it also includes Social Security Numbers (SSNs), Medicare/Medicaid ID numbers, and other health insurance …

WELLTOK ANNOUNCES DATA BREACH AFFECTING HEALTH PLANS, INCLUDING SOME BLUE CROSS AND BLUE SHIELD PLANS Read More »

THE AHA RELEASES REPORT DETAILING INCREASING FINANCIAL PRESSURES HOSPITALS FACE DUE TO RISING REIMBURSEMENT DENIALS AND DELAYS

Last Friday, the American Hospital Association released a 9-page report detailing the increasing financial pressures the nation’s hospitals are facing due to rising reimbursement denials and delays from payers, including Medicare Advantage and commercial plans. Among other things, the report — which analyzed data from 1,300 hospitals across the country — found that the median …

THE AHA RELEASES REPORT DETAILING INCREASING FINANCIAL PRESSURES HOSPITALS FACE DUE TO RISING REIMBURSEMENT DENIALS AND DELAYS Read More »

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