Managed Care Friday

20: Percent of adults who have received a surprise bill for themselves or a family member this year, despite the No Surprises Act that went into effect at the beginning of the year. About 1 in 5 received a bill over $1,000, according to a Morning Consult survey. Those who received unexpected bills were most likely to get them for in-network lab work that was sent to an out-of-network lab. Unsurprisingly, 1 in 4 survey respondents indicated they have skipped or delayed healthcare services because they’re worried about these unexpected costs. Cataract Reversal: Aetna no longer requires prior...

Weekly Medicaid Update

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: NJ: Medicaid to increase rates for maternity services OK: Gov. Sitt announced new healthcare model for the Medicaid program LA: State raises rates over 30% for ABA services provided by techs Click to read more.

Payor Contract Developments

Working Knowledge Of Payor Contracts: In a recent case study, BRG reviewed write-offs from commercial payor denials and found that claims that had been submitted using nationally accepted CPT coders were denied. Click to read more.

BRG Quarterly Compliance Developments

The BRG Healthcare Transactions and Strategy quarterly compliance bulletin compiles noteworthy developments in the healthcare sector related to compliance, program integrity, and enforcement activities. In the second quarter of 2022, we have taken note of:​ DOJ/HHS activity ​ OIG Medicare Advantage Prior Authorization Report​ Three Comparative Billing Reports ​ Two GAO reports​ OCR activity ​ Approved and proposed additions to the RAC audit list ​ Click to read more.