A wave of hospital bankruptcies has brought in its wake high-stakes lawsuits aiming to boost creditor payouts by targeting ...

Like many medical students, I had a difficult time choosing my specialty. I vacillated between a surgical, more procedure-oriented field and one focused on medicine. In 2003, and probably still today, ...

A Pennsylvania health system filed suit this week against Aetna, challenging a policy around "downcoding" that has drawn ire from providers. Philadelphia-based Jefferson Health said in a complaint ...

MedPAC answers the dollars-and-cents question—how much more Medicare pays MA plans due to favorable selection and upcoding than it would spend if MA beneficiaries were in traditional ...

The Centers for Medicare & Medicaid Services has proposed a 2.4% Medicare pay hike for fiscal 2027 and is developing ways to eliminate payment “creep” under the Patient Driven Payment Model. The 2027 ...

Bob Herman covers health insurance, government programs, hospitals, physicians, and other providers — reporting on how money influences those businesses and shapes what we all pay for care. He is also ...

While artificial intelligence solutions can reduce administrative burden in prior authorizations and billing, organizations are reporting increased transaction volumes and higher costs, according to a ...

As audits and downcoding become more common, audit defense isn’t a back-office function. It’s a financial imperative.” — Moghis Uddin, CEO of AlethianAI ...

Easter will be celebrated this year on Sunday, April 5. Though widely associated with the Easter Bunny, colorful eggs, and baskets of chocolate, it's a significant holiday for members of the Christian ...

Tennessee hospitals report that health insurance red tape is delaying patient care and straining resources. Lawmakers are considering two bills to increase transparency and accountability for health ...

One of the most somber days of the Christian calendar has arrived: Good Friday. The holy day, which takes place a couple of days before Easter, commemorates Jesus Christ's sacrifice, more specifically ...

The average pay increase for Medicare Advantage (MA) plans in 2027 will be 2.48%, a substantial increase from the 0.09% that the Centers for Medicare & Medicaid Services (CMS) originally proposed in ...