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Medicare Advantage

How Private Health Insurers May Respond to FDA LDT Regulation

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UnitedHealth Group Faces DOJ Antitrust Probe

CEO SUMMARY: Recent events have not been kind to UnitedHealth Group and its subsidiaries UnitedHealthcare and Optum. In February, just as UHG’s Change Healthcare division was hit with a major cyberattack that disrupted billions of dolla…

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Payer Contracts with Labs: Getting the Contract Is Just the Start

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CMS Issues AI Guidance for Medicare Advantage

CEO SUMMARY: With its guidance on how Medicare Advantage plans should use artificial intelligence (AI) when making treatment decisions involving individual patients, the federal Centers for Medicare and Medicaid Services has opened one door in the coming debate on how the federal governme…

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Lab Data Crucial to Insurer Risk Adjustment Models

CEO SUMMARY: Payers who use risk adjustment models as part of Medicare Advantage need diagnostic data that helps them document ICD-10 diagnoses that earn them higher premium payments for sicker pat…

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Private Health Insurers Are Aware of Problems with CPT Code 81408

EDITOR’S NO…

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Lab News Briefs: Joint Commission, Bon Secours, Anthem, Walmart

Joint Commission Looks at Cyberattacks The Joint Commission issued a Sentinel Event Alert for hospitals to address cyberattacks. The alert pr…

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Big Employers Sue Payers over Price Transparency

CEO SUMMARY: Feeling they’ve been denied access by insurance companies to price data about medical claim payments, self-funded employer plans and unions are taking their health insurance companies…

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Smaller Labs Must Verify Z-code Arrangement with Lab Companies

EDITOR’S NO…

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With Z-codes, Will Other Payers Follow UnitedHealthcare’s Lead?

EDITOR’S NOT…

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