Going their own way: Numerous hospitals opt out of Blues settlement
Several large health systems and dozens of other hospitals and healthcare providers are pursuing antitrust litigation against Blue Cross Blue Shield (BCBS) after opting out of a record-setting settlement. Lawsuits are known to have been filed against the insurer in California, Illinois and Pennsylvania federal court since March 4, the deadline for hospitals to opt…
Congressional hearing highlights the favored approach to cutting Medicaid funding
A recent hearing of the House Oversight and Government Reform Committee showcased the rationale Republicans will use in pursuing significant Medicaid spending cuts. The Feb. 25 hearing was called to examine various federal programs that made the Government Accountability Office’s (GAO’s) High-Risk List for 2025. Because of the ongoing stakes for Medicaid, much of the…
How AI and automation are revolutionizing revenue cycle operations for faster, more accurate reimbursement
Revenue cycle management (RCM) is a critical component of healthcare operations, yet providers face mounting challenges in ensuring timely and accurate reimbursements. Manual processes, evolving regulatory requirements and administrative inefficiencies contribute to revenue leakage and operational burdens. Traditional RCM processes are labor-intensive, relying heavily on manual billing, coding and claims submission. These inefficiencies not only…
Where value-based payment is headed during the second Trump administration
Like much of federal healthcare policy in the next few years, the push to improve value-based payment and accountable care figures to be influenced by two distinctive aspects of the Trump administration: MAHA and DOGE. MAHA is Make America Healthy Again, the movement championed by new HHS Secretary Robert F. Kennedy Jr., while DOGE is…
Settlement participation in Blues litigation may pose concerns for hospitals, attorney says
As the deadline fast approaches for hospitals to decide whether to participate in a record-setting class-action settlement with Blue Cross Blue Shield, competing views of the situation remain. By March 4, hospitals have to alert the settlement administrator if they want to opt out of the $2.8 billion agreement, which also includes injunctive relief said…
Price transparency enforcement gets a boost as Trump signs executive order
Hospitals can expect stepped-up enforcement of price transparency rules now that President Donald Trump has signed an executive order (EO) on the topic. In his Feb. 25 order, Trump noted that his first administration drafted the two sets of regulations requiring providers and insurers to make prices available to healthcare purchasers. He thinks the Biden…
Fatal shooting at Pa. hospital renews calls for legislation to enhance security
A deadly shooting at a hospital in Pennsylvania prompted additional calls for steps to increase the security of healthcare settings. On Feb. 22, a gunman took hostages in the ICU at UPMC Memorial Hospital in York, Pa. During the standoff, local police officer Andrew Duarte was shot and killed, while three hospital staff members and…
Medicaid proponents weigh in as potentially big cuts come under consideration on Capitol Hill
Feb. 26 update: In a vote on the evening of Feb. 25, the House passed the budget resolution. Specifics of the spending cuts will now be drafted by the respective House committees, and the House and Senate will then have to agree on the final bill. Supporters of healthcare providers and consumers are growing increasingly…
Deadline nears for deciding whether to partake in $2.8 billion Blue Cross Blue Shield settlement
In less than two weeks, healthcare providers face a deadline to decide whether to stay in a record-setting settlement stemming from a class-action lawsuit against Blue Cross Blue Shield (BCBS). The $2.8 billion settlement, a portion of which is available to any provider that furnished items or services to a Blues plan member between July…
Trump administration starts to tweak the Affordable Care Act as subsidy debate looms
Coming off a period of record enrollment, the Affordable Care Act (ACA) insurance marketplaces face the prospect of constriction in upcoming years. The Trump administration quickly moved to limit federal funding for a program that helps people select an ACA health plan. On Feb. 14, the administration announced that funding for the ACA Navigator program…