On Tuesday, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) released the results of a report that found improper coding in emergency department procedure codes led to $15 million in improper or potentially...White Papers, E books, Reports and more
The use of AI in medical billing has been criticized for allowing insurance companies more opportunity to issue claims denials and entrench the use of prior authorization in billing. But a new report from the Blue Cross Blue Shield Association (BCBSA) shows that they're not the only side using AI in medical billing to its...National News
The White House has spent the past several weeks shaking up leadership within the Department of Health and Human Services (HHS), responding to criticisms and polling on the public's perception of the vaccine schedule overhaul. But the Make America Healthy Again (MAHA) movement may be too entrenched in the anti-vaccine movement for that...
Eli Lilly is pivoting to employers to sell its GLP-1 agonist weight loss drug Zepbound directly to patients through a new platform that aims to clarify coverage options and lower out-of-pocket costs for employees.
The pharmaceutical giant intends to use the Employer Connect platform to help employers combine medication with services...
Over the past year, the healthcare sector has buoyed the national jobs market even as other workforces experienced exceptional turmoil, healthcare added jobs to an otherwise stagnant workforce. In February, the market stopped being a workforce haven.
Over 28,000 jobs in healthcare were lost in February, the Bureau of Labor Statistics...
The healthcare sector is aggressively incorporating AI into all levels of productivity as products become available to meet the market's niche needs. This week, the Healthcare Information and Management Systems Society (HIMSS) Global Health Conference and Exposition in Las Vegas showcases the breadth of AI capabilities.
Systems that...
In a presentation last week, the Medicaid and CHIP Payment and Access Commission reviewed how states and the federal government monitor Medicaid managed care organizations, which cover about 74% of Medicaid beneficiaries and account for more than half of program spending.
As in Arizona, most Medicaid beneficiaries are now enrolled in...Arizona News
Northern Arizona Healthcare (NAH), a system based in Flagstaff, announced the official start of construction on a new cancer center at Verde Valley Medical Center (VVMC) in Cottonwood. The new center is part of a plan announced last fall to centralize oncology services across the Verde Valley, the move will lead to the closure of the...
Hospital expenses grew 7.5% in 2025, more than twice the rate of hospital price growth, according to this week's American Hospital Association’s Costs of Caring report, highlighting mounting cost pressures across the hospital sector.
The report found workforce expenses remain hospitals’ largest cost driver, accounting for about...
This week, Arizona Republican Congressman David Schweikert, who chairs the Joint Economic Committee (JEC), highlighted new findings from the committee suggesting Medicare Advantage (MA) payment policies may be contributing to higher premiums for seniors enrolled in traditional Medicare.
Although discussion of MA overpayments often...National News
The Centers for Medicare and Medicaid Services (CMS) issued a notice to Elevance Health that it will no longer be allowed to enroll people in Medicare Advantage plans beginning March 31. The sanctions follow what CMS calls a "substantial and persistent noncompliance" with risk adjustment data submission.
The announcement was made via...White Papers, E books, Reports and more
A new analysis from the Medicare Payment Advisory Commission (MedPAC) suggests physician participation in Medicare Advantage (MA) remains widespread nationwide, even as network turnover and contracting dynamics continue to shape how beneficiaries experience access to care.
MedPAC’s review of the 2023 MA market found a large...Arizona News
Late last month, U.S. District Judge Rosalyn Silver ordered Arizona's prison healthcare system into receivership, transferring authority over all prison medical services to a court appointed official. The decision garnered criticism from Arizona Governor Katie Hobbs and others across the state for the unprecedented action.
Governor...National News
Early last month, President Donald Trump signed the Consolidated Appropriations Act of 2026, which included a provision to extend the waiver for hospital-at-home programs through September 2030.
Health systems are taking the opportunity to expand in-home acute care programs to attract a wider array of patients and include new services...Arizona News
The Department of Veterans Affairs has eliminated thousands of medical positions that were left vacant following resignations and retirements last year. The agency's cuts represent a smaller reduction than the Trump administration desires despite years of concerns with staffing shortages.
The cuts include 1,500 physician positions and...
For Arizona policymakers and Medicaid plans, the Office of Inspector General's Colorado findings highlight a growing tension between program oversight, the rapid expansion of private equity-backed applied behavior analysis (ABA) providers and the ability of families to access consistent therapy for children with autism.
The issue drew...
Despite the sweeping investigation that revealed a massive fraud scandal billing Arizona's Medicaid program, new investigations into behavioral health fraud and fake sober living homes targeting Indigenous communities continue to turn up illegal activity.
At the scandal's height in 2023, the number of ongoing investigations into...
A new RAND analysis of the Medicaid provisions in the One Big Beautiful Bill Act suggests Arizona could face some of the largest fiscal and enrollment impacts in the country over the next decade.
The research report published last week finds that expansion states with heavy use of state-directed payments and provider...
Last week, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) released a white paper on its recommendations for value-based care model alignment policies for nursing facilities and assisted living communities.
AHCA argues in the paper, titled "Advancing Accountable Care for Long Term Care...Arizona Comings & Goings
Warren Whitney was promoted to chief administrative officer for Valleywise Health, he was formerly the SVP of government affairs.Arizona Comings & Goings
Scott Trenter is now the vice president of sales at Curatus, a provider data management technology company. He was formerly the director of payor relations and contracting at Dominion Diagnostics.Arizona Comings & Goings
Chad Johnson is now providing oversight for Phoenix Children’s Medical Group administrative operations. He also serves as the the senior vice president of Phoenix Children’s Care Network.Arizona Comings & Goings
Virginia “Ginny” Rountree announced Feb. 2 that she would resign as director of AHCCCS, citing personal health concerns. Rountree had a short tenure, she was appointed October 6 and her final day was Feb. 13.
Roberta Harrison, a longtime Arizona Department of Economic Security official, now serves as interim AHCCCS...Arizona Comings & Goings
Jennifer Greening was promoted to the role of chief financial officer for Southwest Medical Imaging (SMIL). She was formerly a CPA within the organization....Arizona Comings & Goings
Jennifer Erickson is the new chief executive officer of Sonora Quest Laboratories. Erickson is taking over from David Dexter who is retiring next month after more than 26 years of leadership.
Erickson was formerly the chief financial officer and chief operating officer at Clin-Path Associates/Pathology Specialists of Arizona. She...
CMS Rules
