Healthcare Payers

MGMA: EFT Fees Imposed by Health Plans Are Hurting Providers

August 15, 2023 - Electronic funds transfer (EFT) fees imposed by health plans and third-party vendors are increasing costs and administrative burdens for healthcare practices, according to a position paper from the Medical Group Management Association (MGMA). The Affordable Care Act required health plans to offer medical practices the option of receiving...

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AHA: Health Insurer Policies Fuel Physician Practice Acquisitions

by Victoria Bailey

Health insurer policies are increasing administrative burden for independent physician practices, pushing them to seek employment in other settings and fueling physician practice acquisitions, a report...

Provider Groups Band Together to End Cigna’s Modifier 25 Policy

by Jacqueline LaPointe

The American Medical Association (AMA) and more than 100 other provider trade associations have taken issue with a new policy from The Cigna Group regarding claims with modifier 25. Cigna recently...

Value-Based Payment, Fee-for-Service Levels Hold Steady

by Jacqueline LaPointe

Value-based payment levels barely moved in 2021, with some movement in the downside financial risk category, according to the latest data from the Health Care Payment Learning and Action Network (HCP LAN). The majority of healthcare...

Uninsured Rate Falling as Public Coverage Increases

by Jacqueline LaPointe

It stands to reason that providers are treating more patients with health insurance. A new report from the US Census Bureau shows that the percentage of people covered by some type of health insurance...

Most Consumers Look to Payers for Healthcare Price Transparency

by Jacqueline LaPointe

Not many consumers are asking how much healthcare services cost but among those who do, they are seeking answers primarily from their insurance companies, according to a new poll on healthcare price...

Claim Denial Rates as High as 80% for Some Marketplace Payers

by Jacqueline LaPointe

Claim denial rates varied significantly among Healthcare.gov marketplace payers, with some insurers racking up rates as high as 80 percent, according to a new analysis from Kaiser Family...

Hospital Prices 224% Higher for Private Payers than Medicare

by Victoria Bailey

On average, private payers paid hospitals 224 percent of what Medicare would have paid for the same inpatient and outpatient services, according to a report from the RAND Corporation. Researchers used...

Hospital Prices Paid by Commercial Health Plans Varied Across US

by Victoria Bailey

Hospital prices paid by commercial health plans varied between 2012 and 2019, as hospitals with both high and low initial commercial to Medicare price ratios saw increases and decreases over the years,...

Coronavirus Healthcare Spending Dwindles, Threatening Health Equity

by Hayden Schmidt

The coronavirus pandemic spawned a wave of government spending that increased health equity for uninsured or underprivileged people and encouraged access to care for all. That wave of funding is now drying up, with billions of dollars set...

Consumers Don’t Pay Patient Financial Responsibility After Bad Experience

by Sarai Rodriguez

Consumers report a negative experience will dissuade them from paying full patient financial responsibility, according to the 2021 Healthcare Consumer Experience Study from Cedar.  In the survey...

Lawmakers Accuse Nurse Staffing Agencies of Price Gouging

by Sarai Rodriguez

In a letter to the White House, lawmakers urged an investigation looking into suspected price gouging by nurse staffing agencies.  The surge in COVID-19 cases placed immense pressure on the...

Key Characteristics for Successful Downside Risk Contracting

by Erin McNemar, MPA

Organizations that do strong vendor relationships, invest in the organization, and are willing to take on commercial risk will be poised to take on downside risk financial contracts. Through working...

MGMA Calls on CMS to Prevent EFT Fees, Predatory Business Tactics

by Jill McKeon

The Medical Group Management Association (MGMA) penned a letter to CMS urging the agency to use its authority to prohibit unfair electronic funds transfer (EFT) fees imposed on medical groups by health...

Report Identifies Markets Ripe for Payvider Adoption, Growth

by Jacqueline LaPointe

“Payvider” adoption is increasing but some areas are riper for growth than others, according to a recent analysis by healthcare consulting firm Guidehouse. A payvider is a provider...

Healthcare Payment Reform is Critical to Improving Primary Care

by Jill McKeon

High-quality primary care implementation requires significant healthcare payment reform, expanded telehealth capabilities, and team-based care, according to a recent report from the National...

CT Physicians Accused of “Price Gouging” COVID-19 Tests

by Jacqueline LaPointe

A group of physician practices in Connecticut suing Cigna over COVID-19 reimbursement is actually exploiting a national health emergency by overcharging for COVID-19 tests, the payer recently told a...

Reimbursing at Medicare Rates to Cut Healthcare Spending by $352B

by Jacqueline LaPointe

Healthcare spending would be about $352 billion lower in 2021 if private payers reimbursed providers at Medicare rates, according to a new analysis from Kaiser Family Foundation. The analysis of data...

Low-Value Care Spending Slows as Medicare Pushes Value-Based Care

by Hannah Nelson

Low-value care spending among fee-for-service Medicare recipients dropped slightly from 2014 to 2018. However, two of the three services that make up the majority of low-value healthcare spending,...

AHA Decries UnitedHealthcare’s Diagnostic, Drug Coverage Policies

by Jacqueline LaPointe

The American Hospital Association (AHA) is seeking immediate relief from UnitedHealthcare’s new benefit design program that would restrict in-network diagnostic providers. The hospital group...

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