Practice Management
This month, Banner Health is moving to a cashless payment system as a cost-savings measure, according to a press release. The nonprofit system has rolled out the cashless model across Arizona and will phase in the policy across other locations (California, Colorado, Nebraska, Nevada, and Wyoming ) in the coming months with a target date to complete the transition by March 2026. Cash collection creates administrative costs that represent more than a third of the …
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Highmark Health is finding that artificial intelligence (AI) can influence reimbursement, according to Modern Healthcare. The integrated system’s insurance unit posted an operating loss that was tied to higher utilization as well as an increase in coding accuracy coming from providers in their claim submissions. Thanks to AI, providers are more likely to submit cleaner claims that better reflect the reality of clinical care and patient acuity—which also may incur higher reimbursement. It’s not fraud, …
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Optum—the large subsidiary of UnitedHealthcare that delivers clinical care and employs physicians and other providers—is scaling back some of its specialty services and locations in New Jersey, according to local outlet NJ.com. Letters notified patients that about 90 locations in the state would shutter in December, reducing its offerings in several areas, such as behavioral health, dermatology, and orthopedics. However, a spokesperson told Patch providers would continue to offer pediatric, primary care, cardiology, rheumatology, and …
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Healthcare executives meeting at the J.P. Morgan Healthcare Advisory Council in New York recently highlighted how rapidly the health sector is shifting under technological, financial, and policy pressures. In terms of technology, artificial intelligence (AI) is now delivering real-world operational benefits, including shorter hospital stays, faster workflow automation, and reduced administrative burdens associated with clinician documentation, they said at the meeting. Leaders also noted that organizations need to sketch out scenario-based plans because major Medicaid …
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Merck recently announced its intent to acquire Cidara Therapeutics in a deal with a total transaction value of approximately $9.2 billion. Cidara’s pipeline includes an experimental long-acting antiviral drug that has the potential to offer single-dose, universal prevention against influenza A and B. Known as “CD388,” the pipeline product is not a vaccine but a low molecular weight biologic. It is expected to offer seasonal protection for various populations, including immunocompromised individuals. The transaction is …
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The Urgent Care Association (UCA) continues to seek differentiation for urgent care in the place of service (POS) definitions used by the Centers for Medicare and Medicaid Services (CMS) to construct payment schedules, which are updated yearly. In the 2026 Medicare Physician Fee Schedule, UCA’s advocacy efforts were noted in the Federal Register document with a statement indicating comments offered about the POS for urgent care will be taken into consideration by CMS for possible …
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A recent MedCity News survey reveals that providers end up investing about 2-10% of the collection value of their claims on subsequent efforts to chase down payment, scrubbing away at margins and slowing administrative workflows in revenue cycle management. At the same time, 90% of hospital and physician practice respondents say they are at least somewhat interested in artificial intelligence tech tools to make improvements in billing, and about 66% already have experience with such …
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Trends show that some patients are choosing to microdose their glucagon-like peptide 1 receptor agonists (GLP-1RA) prescriptions for diabetes and weight loss, whether a provider advises it or not. It’s believed that microdosing can be helpful to quell significant gastrointestinal side effects or to titrate scheduled dosing with individualized provider recommendations, however, microdosing is still considered unconventional, according to the American Diabetes Association (ADA). For example, each semaglutide multidose pen delivers about 72 unnumbered “clicks” …
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CVS Health plans to close 16 Oak Street Health centers, representing about 7% of its total portfolio of these senior-focused primary care clinics. Doors will shutter by the end of February, and CVS cites rising medical costs as the main reason driving the reduction, according to Forbes. The company did not specify which locations will close but said it will continue to operate 230 Oak Street clinics across 27 states. Increased costs to deliver care …
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Several large health insurers are drawing provider backlash for relatively new payment policies that reduce certain reimbursements. Cigna is automatically downcoding 6 evaluation and management (E/M) billing codes (99204- 99205, 99214-99215, 99244-99245) for a small percentage of providers starting this month, for example, resulting in lower payments for some routine office visits. The insurers are leveraging algorithms and claims data to automatically downgrade the codes—often relying on third party vendors to do the adjustments. According …
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