Author: Scott Welch
Vendors insist their AI-assisted coding tools can correct years of under-documentation, but insurers say the tools are driving up healthcare costs for patients.
Hospitals’ increasing use of artificial intelligence for patient coding has increased the frequency of inpatient stays classified as medically complex—boosting the bills sent to payers despite no apparent changes in the care being delivered, according to a new claims analysis from the Blue Cross Blue Shield Association. The association found that the share of medically ...
Private-sector employers in the United States are facing much higher health insurance costs but struggling to hold their benefits packages together. The Bureau of Labor Statistics painted that picture today in a new batch of National Compensation Survey employee benefits data. The average cost of health benefits for a single employee at a private-sector employer ...
Medicare Advantage insurance companies anticipate another year of enrollment declines, the Centers for Medicare and Medicaid Services announced Monday. Insurers project Medicare Advantage membership will fall from 36.3 million this year to 34 million in 2027, CMS said in a news release. Companies made a similar prediction for the 2026 plan year that failed to ...
Hospitals are facing more hurdles in using the 340B drug pricing program as shifts in insurance coverage make it harder to maintain access to discounted drugs. Health systems are increasingly running into regulatory and legislative barriers to the program that allows safety-net providers to buy deeply discounted drugs from manufacturers. A Corewell Health hospital in ...
The Trump administration has promoted its new TrumpRx website as a way for consumers to get the lowest prices in the world for prescription medications, drawing on voluntary pricing agreements with drug manufacturers aimed at securing “Most Favored Nation” prices for American consumers. A KFF analysis, however, finds that consumers who buy brand-name prescription drugs ...
Autumn Daniels is no stranger to migraine headaches, which have troubled her since childhood. The migraine tormenting the 32-year-old in April was even worse than usual. After a week of piercing head pain, she went to an urgent care center near her home in Champaign, Illinois, and received an injection of Toradol, a non-steroidal anti-inflammatory ...
The most effective strategy for prolonging life might be at the end of a leash. Dan Buettner, longevity expert and founder of the organization Blue Zones in Minneapolis, Minnesota, highlighted a growing body of scientific evidence showing that owning a dog is strongly associated with a reduced risk of early death, particularly from cardiovascular disease. ...
The Trump administration plans to cancel enrollment in Affordable Care Act plans for more than 760,000 people as part of its crackdown on fraud, waste and abuse. The Centers for Medicare & Medicaid Services announced on Tuesday that it would cancel 315,000 “unauthorized enrollments” covering that population, a move the agency said will return $2.2 ...
Blue Shield of California announced Thursday that it plans to expand its Virtual Blue program, doubling program enrollment for members. Beginning in January 2027, the benefit will be included in fully insured preferred provider organization (PPO) plans for employers with 101 to 3,000 employees, as well as for certain individual and family plans, the insurer ...