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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
After the Senate Hearing on Change Healthcare: What Practices Should Do Now
UnitedHealth Group's CEO testified on May 1 about the Change Healthcare attack: a Citrix portal without multifactor authentication, a $22 million ransom, and data on perhaps a third of Americans. Here is what the testimony changes for a practice still reconciling claims, deposits and advances from February and March.
HHS Weighs In on the Change Healthcare Outage: Paper Claims and Funding
On March 5, 2024, HHS issued its first formal statement on the Change Healthcare cyberattack: Medicare contractors will accept paper claims and speed up EDI enrollment, and payers are urged to relax prior authorization and timely filing. Here is what each measure means, and what the UnitedHealth funding program covers.
CMS Finalizes the Prior Authorization Rule: What Changes in 2026 and 2027
On January 17, 2024, CMS released the Interoperability and Prior Authorization final rule (CMS-0057-F). It sets decision deadlines, requires specific denial reasons and mandates a prior authorization API. Here is who it covers, when each piece lands and what to do before then.
UnitedHealthcare and Cigna Cut Prior Authorization: What Changes in Practice
UnitedHealthcare published the codes it will stop requiring authorization for on September 1 and November 1, 2023, about a fifth of its volume. Cigna followed on August 24 with more than 600 codes. Here is what is actually changing, what is not, and how to adjust the authorization workflow without creating new denials.
UnitedHealthcare's 20% Prior Authorization Cut: What Changes for Practices
UnitedHealthcare says it will drop prior authorization for about a fifth of its procedure volume starting in Q3 2023, days after an AMA survey found 94% of physicians see care delayed by authorizations. Here is what was announced, what CMS finalized the same week, and how to run the desk regardless.
No Surprises Act IDR on Hold: What the February 6, 2023 Texas Ruling Changes
A federal court vacated parts of the No Surprises Act arbitration rule on February 6, 2023, and CMS told arbitrators to stop issuing payment determinations. Here is what the ruling changed, which deadlines still run, and how practices should handle disputes while the process is paused.
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