United To End Most PAs On Rural Hospitals
Responding to the rural health crisis and its own bad PR, UnitedHealthcare says it will exempt rural hospitals from most prior authorizations. This will apply across all lines of business. United will also accelerate payments by up to 50% for about 1,500 rural hospitals and all critical access hospitals across the country.
Additional article: https://www.beckerspayer.com/payer/unitedhealthcare-pares-back-prior-authorizations-speeds-up-payments-for-rural-providers/
#unitedhealthcare #priorauthoriztaion #ruralhealthcare
United Financial Storms Subsiding?
United Health Group reports today on its latest financial results and recovery. It is expected to be good news overall. United is making progress. An interesting article, though, outlining the Medicare Advantage (MA) rate challenges and how both United and investors were slow to see the impact on the insurer as well as its services unit, Optum. The article details some of the huge financial misses by United’s former leaders even with clear signals back three years ago. Investors, too, buried their heads in the sand.
Despite some MA rate relief for 2027, the unlinked chart changes will challenge the biggest insurers over time, including United. Some analysts said the overall impact of new changes was going to be $5 billion for United and $2 billion for Humana. The biggest MA plans have the most aggressive risk adjustment coding. United will need to show investors it has baked all of the 2024 to 2026 v28 model impacts into forecasts as well as the 2027 impacts. Assumptions made for recovery were very conservative, though.
(Article may require a subscription.)
#medicareadvantage #riskadjustment #unitedhealthcare
https://www.modernhealthcare.com/insurance/mh-unitedhealth-optum-earnings-medicare-advantage
Medicaid Plans Ramp Up Marketing To Maintain Medicaid Membership
Faced with major enrollment losses due to the One Big Beautiful Bill Act (OBBBA), health plans big and small are ramping up marketing to maintain enrollment in Medicaid. The moves are centered on teaming up with various providers to get the word out on new requirements, such as enhanced eligibility checks and work requirements. Some are investing in job training programs.
(Article may require a subscription.)
#medicaid #obbba #workrequirements #healthplans
https://www.modernhealthcare.com/insurance/mh-medicaid-work-requirements-aetna-centene-marketing
Another No Surprises Lawsuit Tossed
Another No Surprises Act lawsuit has been tossed. Aetna’s lawsuit accusing Radiology Partners of gaming the No Surprises Act (NSA) to win higher reimbursements was thrown out by a federal judge in Florida. The judge found that Aetna did not provide sufficient evidence to prove the group did not join networks and abused the dispute resolution process. It also said Aetna could have used the process to point out any fraud.
Of course, judges are missing the abuse here and Congress and federal agencies need to step in.
Additional article: https://www.modernhealthcare.com/insurance/mh-aetna-radiology-partners-lawsuit-dismissed/
(Some articles may require a subscription.)
#nosurprisesact #transparency #healthplans #providers
— Marc S. Ryan
