HEALTHCARE NEWS

Navigating the No Surprises Act: The Hidden Costs of Ineligible Arbitration Disputes The No Surprises Act, enacted in 2020 as part of the Consolidated Appropriations Act, was hailed as a landmark consumer protection measure. By shielding patients from unexpected out-of-network medical billsR...

Providence and Humana Join Forces to Standardize Payer-Provider Data Exchange: A Step Toward True Interoperability On October 21, 2025, Providence and Humana announced a new collaboration to streamline and standardize data exchange between payers and providers. The initiative leverages FHIR-bas...

The Fraud Detection Failure: Why Billions in Medicaid Managed Care Operate Without Oversight  When the Department of Health and Human Services (HHS) Office of Inspector General (OIG)
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Cigna’s New E/M Coding Accuracy Policy (R49): What Providers Need to Know At a Glance Effective date: October 1, 2025 Policy name: Evaluation and Management Coding Accuracy (R49) Scope: Applies to CPT® E/M codes 99204–99205, 99214–99215, and 99244–992...

The Death Spiral of Independent Medicine: How Payment Policies Are Reshaping American Healthcare  The American healthcare system is experiencing a quiet revolution—one measured not in dramatic headlines but in the steady erosion of independent medical practices across the country. Be...

The Practice Economics Crisis: Why Your Bottom Line Doesn't Match Your Paycheck How rising operational costs are quietly destroying physician practice viability Your salary went up 3.7% last year, according to Doximity's 2025 Physician Compensation Report. Meanwhile, Medicare cut your reim...

No Roads, No Revolution: Why Healthcare’s Broken Data Infrastructure Is Undermining AI Innovation In the age of generative models and multimodal clinical assistants, healthcare AI is often heralded as the next frontier—one poised to solve physician burnout, accelerate diagnosis, and...

NYRx ePA Launch: Transforming Prior Authorization for New York MedicaidThe Dawn of Streamlined Prior Authorization in New York MedicaidHealthcare providers in New York are about to experience a significant shift in how they handle prior authorization requests. Starting July 15, 2025, NYRx, New York'...

The Political Strategy Behind Delayed Healthcare Cuts The recent passage of President Trump's tax and spending bill reveals a sophisticated political strategy that healthcare policy experts have seen before: backloading controversial cuts to minimize immediate electoral consequences. With nearl...

CVS Caremark $95 Million Medicare Fraud Settlement: A Deep Dive into PBM Pricing Practices and Systemic Healthcare Cost Manipulation  The recent $95 million settlement against CVS Caremark represents far more than a single company's misconduct—it exposes the systemic vulnerabilities ...

The AI Prior Authorization Crisis: When Algorithms Override Medical Judgment The healthcare industry stands at a critical crossroads. While artificial intelligence promises to revolutionize medical care, its current deployment in insurance prior authorization systems has created an unprecedente...

The Billing Revolution: How Value-Based Care is Reshaping the Future of Medical Billing The traditional medical billing office—with its towers of paper claims, denial follow-up spreadsheets, and revenue-per-service mentality—is becoming a relic of healthcare's past. In its place, a ...

CMS Bolsters Medicare Advantage Audits to Combat Overbilling and Ensure Accountability The Stakes of Medicare Advantage Oversight Medicare Advantage, a program that allows private insurers to administer Medicare benefits, has grown exponentially over the past two decades. As of 2025, nearl...

UnitedHealth Group Under Scrutiny: What Recent Investigations and Industry Challenges Mean for Healthcare Providers UnitedHealth Group, one of the most powerful forces in the U.S. healthcare system, is currently facing a perfect storm of challenges — federal investigations, leadership cha...

Communication Strategies to Overcome Prior Authorization Tech Hurdles  Prior authorization (PA) stands out as a persistent challenge, bogging down providers with administrative complexities and delaying patient care. While technology offers promising solutions, barriers such as lack of sta...