Search results for Medicare Denials

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savingadvice.com /1 month ago

Medicare Advantage Prior‑Authorization Denials Jumped 56% — New April Rules Aim to Fix It

If you’ve ever had a doctor recommend a treatment—only to be told you need “approval first”—you’ve experienced prior authorization. For millions of seniors on Medicare...

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hitconsultant.net /2 weeks ago

The $262B “Acceptance”: Why It’s Time to Stop Treating Denials as an Unavoidable Cost

I want to be direct about something: the denial problem in U.S. healthcare is not complicated to understand. It is complicated to fix, but the basic dynamic is straightforward. Hos...

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savingadvice.com /2 weeks ago

Medicare’s 72-Hour Decision Rule Begins Now: What Seniors Must Know About Faster Approvals and Denials

Millions of seniors enrolled in Medicare Advantage plans have spent years frustrated by delayed prior authorization decisions for medical care, scans, procedures, and treatments. S...

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fiercehealthcare.com /1 month ago

Despite better cash flow, providers missed out on more revenue in 2025 due to increased payer denials

A review of over 2,300 hospitals' revenue cycle data outlines year-to-year improvements in accounts receivable but a roughly 25% jump in net revenue leakage.

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natlawreview.com /1 month ago

Medicare Payment Suspensions Emerge as a Key Tool in Federal Anti-Fraud Efforts — Focus on California Hospices

Medicare payment suspensions result in a cessation of payments for Medicare services until the suspension is resolved, typically several months after the initial action to suspend....

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fiercehealthcare.com /1 month ago

AI-powered prior authorizations for Medicare have greatly delayed care, Washington state hospitals say

The Centers for Medicare & Medicaid Services' experimental WISeR Model has Medicare patients waiting two to four times longer for procedures, according to a Washington senators...

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jdsupra.com /1 month ago

Medicare Payment Suspensions Emerge as a Key Tool in Federal Anti-Fraud Efforts — Focus on California Hospices

Medicare payment suspensions result in a cessation of payments for Medicare services until the suspension is resolved, typically several months after the initial action to suspend....

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savingadvice.com /1 week ago

CMS’s New AI-Powered Prior Authorization System: Will It Speed Up Approvals or Deny Seniors Critical Care?

For years, seniors and doctors have complained that prior authorization delays can feel like a second illness layered on top of an existing medical problem....

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savingadvice.com /1 month ago

Your 2026 Medicare Advantage Plan May Deny Your Next ‘Emergency’ MRI-Here’s Why

If you’ve ever rushed to the ER or urgent care with severe pain, dizziness, or a possible stroke, you probably assumed your insurance would cover...

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medcitynews.com /1 month ago

Why 131 Hospitals Are Suing HHS Over Alleged Underpayment

A group of 131 hospitals has sued HHS over a CMS policy they say improperly reduces Medicare disproportionate share hospital (DSH) payments. The lawsuit is the latest in a decade-l...

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blogforarizona.net /1 month ago

“Prior Authorization” Makes Medicare Patients Sicken and Die

While America’s largest insurance companies rake in tens of billions in profits, they are simultaneously forcing doctors to beg for permission to treat patients—patients who are of...

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reviewjournal.com /1 month ago

What to do about a fraudulent claim on your Medicare account

Medicare fraud is estimated to cost more than $60 billion a year. A recent newsletter from the government agency offered tips to safeguard against scams.

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natlawreview.com /2 weeks ago

Moratorium on New Medicare Enrollment

CMS is imposing a six-month nationwide moratorium on new Medicare enrollment for hospices and home health agencies in a sweeping effort to combat fraud. Effective immediately, CMS...

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healthcareittoday.com /4 days ago

The Difference Between a Correctly Coded Claim and a Payable One

The following is a guest article by Dr. Jenakan Dev, Co-Founder and CEO at Grelin Health Every revenue cycle leader knows denial rates are increasing industry-wide, in part due to...

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savingadvice.com /2 weeks ago

The Latest Medicare Rule Changes Could Delay Care for Older Americans

Medicare can feel incredibly complicated to navigate, especially with new rule changes rolling out every year. Some of this year’s changes have more seniors worried...

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natlawreview.com /1 week ago

DOJ Seizes $2 Million in Data-Driven Medicare Fraud Action: Key Insights for Health Care Providers

On April 28, 2026, the U.S. Department of Justice (DOJ) announced the seizure of more than $2 million from Expert Wound Care PC, a Pasadena-based wound care clinic accused of defra...

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moneytalksnews.com /1 month ago

6 Medicare Mistakes That Could Cost You Thousands

Medicare is an invaluable program, but be wary of these pitfalls.

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moneytalksnews.com /3 weeks ago

4 Pitfalls That Every New Medicare Enrollee Should Know (Some Could Cost You for As Long As You Live)

Medicare's rules are exacting, and penalties can be stiff and sometimes permanent.

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jdsupra.com /1 month ago

Medicaid Provider Revalidation: Navigating Dr. Oz’s Sweeping Enrollment Audit

On April 23, 2026, Dr. Mehmet Oz, Administrator of the Centers for Medicare & Medicaid Services (“CMS”), sent letters to all governors and State Medicaid Directors requesting t...

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scienceblog.com /3 weeks ago

Medicare Advantage Insurers Break the Rules and Pay Almost Nothing for It

Six dollars and fifty cents. That is, give or take, the largest fine the federal government has ever levied on a Medicare Advantage insurer per patient enrolled. It happened once,...

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kevinmd.com /1 week ago

How Medicare changes affect medical billing contracts

Policy changes eventually become operating decisions Most coverage of Medicare payment changes stops at reimbursement. A practice reads that a rule changes payment for certain serv...

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kevinmd.com /1 week ago

How Medicare changes affect medical billing contracts

Policy changes eventually become operating decisions Most coverage of Medicare payment changes stops at reimbursement. A practice reads that a rule changes payment for certain serv...

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hallrender.com /1 month ago

Health Provider News

NATIONAL 4 senators push CMS to tackle Medicare Advantage upcoding: Bloomberg 7 health systems with boosted outlooks 131 hospitals sue HHS over DSH cuts: 5 notes ACA plans denied 1...

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kevinmd.com /2 weeks ago

Missed claims filing deadlines threaten patient care

I used to think health care finance was mostly about numbers. Then I worked inside the financial operations of a health care organization and realized how much patient care depends...

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