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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 »

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 »

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 »

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 »

Humana, Inc. has reported strong third quarter 2023 earnings, with its adjusted earnings per share of $7.78 beating analysts’ estimates. For the first three quarters of 2023, Humana has earned $3 billion in profit. Humana also announced that it expects to increase its Medicare Advantage membership to 860,000 in 2023, an increase of 19%, and …

HUMANA REPORTS THIRD QUARTER EARNINGS AND ANNOUNCES A SHARP INCREASE IN MEDICARE ADVANTAGE ENROLLMENT Read More »

Beating analysts’ expectations, the Cigna Group reported strong profits of $1.4 billion and revenues of $49 billion for the third quarter of 2023. Through the first nine months of the year, Cigna reported $4.1 billion in profit and $144.2 billion in revenue. Cigna’s revenue growth was particularly strong in its health insurance business, Cigna Healthcare. …

THE CIGNA GROUP REPORTS STRONG PROFITS FOR THE THIRD QUARTER OF 2023, BEATING ANALYSTS’ EXPECTATIONS Read More »

Whatley Kallas, LLP is representing 340B hospitals seeking recovery from Medicare Advantage plans for past underpayments for outpatient drugs.  Now that CMS has issued its final rule requiring a one-time lump sum payment for the underpaid 340B drugs from the Medicare Program, it is time for 340B hospitals to demand these payments from Medicare Advantage …

CMS ISSUES FINAL RULE REQUIRING LUMP SUM PAYMENTS TO 340B HOSPITALS FOR UNDERPAID OUTPATIENT DRUGS Read More »

CVS Health Corporation reported strong third quarter 2023 profits of $2.3 billion. It also reported strong third quarter revenues of $89.8 billion, up 8.6% from the prior year quarter. Revenues are up 10.6% for the year compared with 2022.  Both CVS Health’s third quarter profits and revenues beat analysts’ expectations. Revenues were also sharply up …

CVS HEALTH (AETNA) REPORTS STRONG THIRD QUARTER REVENUES AND PROFITS, BEATING ANALYSTS’ EXPECTATIONS Read More »

In a strongly worded letter that includes specific examples of how prior authorization requirements harm patient care, the American Hospital Association has urged CMS to expeditiously finalize its Advancing Interoperability and Improving Prior Authorization Processes proposed rule.  The proposed rule would generally apply to Medicare Advantage plans, state Medicaid and CHIP plans, and plans purchased …

THE AHA URGES CMS TO EXPEDITIOUSLY FINALIZE ITS PROPOSED PRIOR AUTHORIZATION RULE Read More »