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Hospital-backed proposal would make insurers reveal prior auth denial rates

Fierce Healthcare

A recommendation on the 2024 Measures Under Consideration list, brought forward by the Federation of American Hospitals (FAH), would add a quality measure in the Medicare Advantage (MA) star rating | The Federation of American Hospitals is pushing CMS for the inclusion of a star ratings quality measure that shows how often insurers overturn or uphold (..)

Insurance 128
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KFF: Insurers likely to pay out $1.1B in premium rebates this year

Fierce Healthcare

Insurers are likely to pay $1.1 billion in Affordable Care Act medical loss ratio rebates in 2024, according to a new analysis. Insurers are likely to pay $1.1 billion in Affordable Care Act medical loss ratio rebates in 2024, according to a new analysis.

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STAT+: New Medicare Advantage star ratings give extra bonuses to multiple insurers

STAT

More than two dozen Medicare Advantage insurers received higher quality marks for 2024, based on a STAT review of new data released July 2 by the federal government. Federal courts required the Centers for Medicare and Medicaid Services to make changes after ruling the agency made mistakes with its own methodology.

Insurance 123
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STAT+: Elevance tumbles as health insurer warns Medicaid members are using more care

STAT

Wall Street’s reaction was swift Wednesday after Elevance Health said that the amount of care its Medicaid members are getting is outpacing what states are paying the insurer to treat those members.

Insurance 132
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STAT+: New Medicare Advantage rule is boon for providers, drag on insurers

STAT

As hospitals and health insurers release their profit projections for 2024, it’s become clear that this change — largely overlooked when it was announced — could have a marked effect on companies’ finances.

Insurance 129
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Elevance Health wants to use AI to simplify and personalize healthcare. Here's how the insurance giant is doing it

Fierce Healthcare

The health insurance giant, which serves 117 million people, sees opportunities to leverage generative AI and other technologies to make healthcare easier to navigate, chief AI officer Shawn Wang said during an interview at CES 2024.

Insurance 126
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STAT+: Biden administration floats major 2024 pay cut for Medicare Advantage plans

STAT

Medicare Advantage insurers could face an average 2.3% cut to baseline payments in 2024, the Biden administration said Wednesday. The major reason behind the proposed pay cut: Medicare officials want to update data and coding systems that are used to explain the health conditions of an insurance company’s enrollees.

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