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Compliance

This section focuses on health care compliance and regulations – both national and state – including the ACA. It includes changes in health care law, regulation, and court decisions and their impact on health insurance professionals, employers, and individuals.

After Public Push, CMS Curbs Health Insurance Agents’ Access to Consumer SSNs

Until last week, the system that is used to enroll people in federal Affordable Care Act insurance plans inadvertently allowed access by insurance brokers to consumers’ full Social Security numbers, information brokers don’t need.

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As Compliance Become More Complex, Employers Turn To Brokers For Guidance, Survey Finds

Sixty-nine percent of brokers cited ever-changing federal and state mandates as a leading market force driving their firms to add new products and service offerings.

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Biden Expands Window To Try And Keep Millions More Low-Income Americans Insured

President Joe Biden is widening a critical window for low-income Americans to join Obamacare, in a move aimed at reinforcing a central element of his reelection bid: That he presided over a historic expansion of health care coverage.

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Hospitals Are Adding Billions in ‘Facility’ Fees for Routine Care

Tim Ebel’s visit with an ear, nose and throat specialist at an Ohio clinic last October came to $348. At the same time, he got a second bill for $645. The hospital system that owns the Avon, Ohio, clinic had charged him separately for use of the office where he met his physician. It is ...

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Providers ‘Wasted’ $10.6B In 2022 Overturning Claims Denials, Survey Finds

More than 100 provider organizations want the Centers for Medicare & Medicaid Services (CMS) to take a tougher stance on Medicare Advantage (MA) plans’ practices following an industry survey estimating billions per year are spent fighting claims denials. Providers spent nearly $20 billion in 2022 pursuing delays and denials across all payer types, yet those ...

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Breaking Down Biden’s $7.3T Proposed Budget For 2025: Here Are His Top Health Priorities

The administration said his budget (PDF) will lower healthcare costs and drug prices, expand access to prescription drugs, build upon the Affordable Care Act (ACA) and fortify Medicare through a tax on the wealthy. Many of these priorities were previewed during Biden's State of the Union address last week.

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US Government Calls For Insurance Companies To Make Advanced Payments Following Cyberattack Disruption

The US government on Sunday urged insurance companies to make advanced payments to health care providers following a cyberattack that disrupted insurance processing systems. The cyberattack had “significant impact” on Change Healthcare, a unit of health IT giant UnitedHealth Group, which processes 15 billion health care transactions annually. CNN previously reported that the cyberattack has resulted ...

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Federal Appeals Court Hears Arguments In ACA’s Free Preventive Care Mandate Case

For now, insurers and employers are still not required to cover certain free preventive care services, such as cancer screenings and HIV-preventing medications, until the federal appeals court makes its decision later this year.

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California Attorney General Boosts Bill Banning Medical Debt From Credit Reports

California Attorney General Rob Bonta announced Monday that he is throwing his weight behind legislation to bar medical debt from showing up on consumer credit reports, a Democratic-led effort to offer protection to patients squeezed by health care bills. Bonta is a sponsor of Sen. Monique Limón’s bill, which seeks to block health care providers, as ...

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‘Cybersecurity Is Patient Safety’: What The Ransomware Attack On Change Healthcare Should Teach The Industry

As the disruption caused by the cyberattack at Change Healthcare stretches beyond its tenth day, cybersecurity experts say the incident could spur greater emphasis on enhancing protocols—and greater oversight from the feds.

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