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Reimbursement
Bill would expand access to digital therapeutics
Revenue Cycle Management
Cleveland Clinic to debut AI tools for revenue cycle
Strategic Planning
WebMD CMO Dr. John Whyte selected as new CEO of the AMA
Capital Finance
Orlando Health, Watson Clinic partnering on new hospital
Supply Chain
Trump releases executive order to speed domestic drug production
Accounting & Financial Management
Aetna exiting ACA markets as CVS logs $1.8B in profit
Budgeting
Health system operating margins declined in August
Quality and Safety
Kaiser Permanente fined $819K for delays in handling member complaints
Billing and Collections
Revenue cycle challenged by low collection rates, high denials
Claims Processing
Optum levying strict measures on Change outage loan repayment
Workforce
New York-Presbyterian laying off 2% of workforce
Operations
Revenues and expenses up, margins down for nation's hospitals
Medical Devices
Payers' member digital experiences lagging
Hospital/physician relations
Hospitals, physicians submit opposing views to FTC ruling
Construction & Facilities Management
Hartford HealthCare teams with MSK on cancer center
Compliance & Legal
UnitedHealth Group investigated over potential criminal Medicare fraud
Policy and Legislation
$715B Medicaid cut passes House committee in reconciliation bill
Community Benefit
Mobile Healthcare does house calls
Accountable Care
HIMSS25 session shows how physicians are incentivized in APMs
Acute Care
CMS proposing 2.4% increase for hospice care
Ambulatory Care
Cleveland Clinic partners with Regent Surgical for ambulatory surgery centers
Analytics
Yale New Haven Health data breach affects 5M
Business Intelligence
Dowling stepping down as Northwell CEO after 23 years
ICD-10 & Coding
Practices keeping close watch on risk adjustment coding
Meaningful Use
Financial disincentives for providers who commit information blocking
Medicare & Medicaid
CMS closing loophole it says states exploit to benefit illegal immigrants
Patient Engagement
HIMSSCast: 'How do we grow again?'
Pharmacy
Reforms are needed in the 340B drug program, Senate report says
Population Health
Enrollment in ACA exchanges has exploded in recent years
Risk Management
UPMC for You offers Medicaid redetermination coverage in laundromats
Telehealth
Alliance for Connected Care outlines policy requests to CMS
Mergers & Acquisitions
CareSource finalizes Commonwealth Care Alliance acquisition
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Payers must change dynamic with providers to survive in the post-Affordable Care Act world
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Systems see uptick in use of adversarial AI
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Top Stories
UnitedHealth Group CEO Andrew Witty steps down
Dowling stepping down as Northwell CEO after 23 years
CMS closing loophole it says states exploit to benefit illegal immigrants
Claims Processing
Apr 29 | Susan Morse
Allegheny Health uses AI for prior authorization automation
The health system and Optum Ventures are among more than 10 investors in physician-led AI company Humata Health.
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Apr 22 | Jeff Lagasse
Elevance Health meets expectations with $2.2B in Q1 profit
Revenue is also up, hitting $48.9 billion in Q1, a 15% jump as compared to $42.6 billion a year ago.
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Apr 21 | Susan Morse
26 rural hospitals launch the Ohio High Value Network
This is the third such collaboration of rural hospitals operated by the for-profit Cibolo Health.
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Apr 15 | Susan Morse
Optum levying strict measures on Change outage loan repayment, AMA says
AMA wants Optum to stop its approach for recouping loans and to suspend all claim filing deadlines.
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Apr 11 | Susan Morse
Many payers, providers unprepared for interoperability and prior authorization rule, WEDI finds
Starting Jan. 1, 2026, payers must send prior authorization decisions within 7 days and…
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Feb 26 | Susan Morse
Sen. Grassley wants UnitedHealth to hand over MA billing records
Letter to CEO Andrew Witty follows report of DOJ launching investigation into the company's billing methods.
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Feb 14 | Jeff Lagasse
Class action lawsuit against UnitedHealth's AI claim denials advances
The plaintiffs have accused the insurer of using artificial intelligence algorithms to illegally deny claims.
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Feb 04 | Jeff Lagasse
Cigna to accelerate prior authorization and tie executive pay to member satisfaction
Initiatives include adding new concierge teams to support customers experiencing challenges with claims…
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Feb 03 | Jeff Lagasse
Healthcare.gov plans denied 20% of claims in 2023
Reasons include prior authorization or referral, excluded services and administrative issues, KFF finds.
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Jan 28 | Jeff Lagasse
190 million people affected by Change Healthcare cyberattack
The figure of 190 million people has been amended from past estimates, which put the total at about 100 million.
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