Billing Management

The Hidden Costs and Financial Risks of Medicare in Retirement
Infrastructure & Management The Hidden Costs and Financial Risks of Medicare in Retirement

Many Americans view the milestone of their sixty-fifth birthday as a financial finish line, a moment when the lifelong burden of healthcare premiums and unpredictable medical bills finally gives way to the security of a government-backed safety net. Standard Medicare coverage is structurally

States Use Medicare Benchmarks to Limit Hospital Prices
Infrastructure & Management States Use Medicare Benchmarks to Limit Hospital Prices

Legislators in Vermont are focusing on transparency by mandating that any savings generated from hospital price regulation must be reflected in the monthly premiums paid by citizens. This initiative represents a broader movement across the United States where state governments are abandoning the

Can Florida Stop PBM Giants From Fixing Pharmacy Prices?
Infrastructure & Management Can Florida Stop PBM Giants From Fixing Pharmacy Prices?

Florida's lawsuit asserts that the 2019 deal between Express Scripts and Prime Therapeutics effectively removed the competitive incentive for PBMs to offer fair rates to retail pharmacies. This legal challenge highlights a growing concern that the pharmaceutical supply chain has become increasingly

Rep. Harshbarger Demands Transparency in AMA Medical Coding
Infrastructure & Management Rep. Harshbarger Demands Transparency in AMA Medical Coding

Lawmakers are scrutinizing the American Medical Association’s internal processes to ensure that private interests do not dictate the reimbursement rates for life-altering medical procedures. Representative Diana Harshbarger, a Tennessee Republican and a career pharmacist, has formally challenged

Is Pediatric Gender Medicine Facing a Federal Fraud Probe?
Infrastructure & Management Is Pediatric Gender Medicine Facing a Federal Fraud Probe?

The White House Task Force to Eliminate Fraud is currently analyzing evidence to determine if pediatric gender medicine has been used as a vehicle for deceptive financial gain at the taxpayer's expense. This inquiry represents a fundamental shift in the federal approach to controversial medical

R1 RCM Acquires Humata Health to Automate Authorizations
Infrastructure & Management R1 RCM Acquires Humata Health to Automate Authorizations

A significant portion of insured patients identify the slow pace of authorization approvals as their primary obstacle when trying to access necessary treatment. This administrative bottleneck often leads to delayed procedures, increased clinician burnout, and frustrated patients who are left

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