Ghosts in the Network
How Inaccurate Medicaid Managed Care Provider Directories Undermine Real Access to Maternal Care in the United States By Elena Pak,…
Criminalizing Coverage Denials?
What Pennsylvania’s New Bill Reveals About the Growing Backlash Against Health Insurers By Elena Pak, Credentialing Department, WCH When Pennsylvania…
When a Half-Star Is Worth Hundreds of Millions
The Clover Health Ruling May Be Less About One Insurer—and More About a Growing Crisis of Confidence in Medicare Advantage…
Deny First, Approve Later?
New Federal Findings Raise Questions About Whether Medicare Advantage Prior Authorization Is Functioning as a Clinical Safeguard—or a Cost-Control Tool…
One in Five Patients Denied Care: Why This Matters to Every Medical Practice
By Elena Pak, Credentialing Department, WCH A new survey from the Commonwealth Fund found that one in five privately insured…
ACA Under Fire Again: Why Cities Are Suing Over New Marketplace Rules — and Why Providers Should Pay Attention
By Elena Pak, Credentialing Department, WCH A new legal challenge against federal Affordable Care Act (ACA) marketplace regulations may appear…
The MultiPlan Litigation: Why Every Provider Should Be Paying Attention
For years, many physicians, hospitals, ambulatory surgery centers, and specialty practices have shared a common frustration: out-of-network reimbursements that seemed…
Medical Necessity Under the Microscope: What a $6.73 Million DOJ Settlement Means for Procedural Practices
The Department of Justice recently announced that a California vascular practice and its owner physician agreed to pay more than…
Surgical Coding: The Global Period Is Not Bureaucracy. It’s a Trap.
By Edita Petrosyan, Billing Department, WCH Why Physicians Lose Money Without Breaking a Single Rule Picture this: you performed a…