The Wasteful and Inappropriate Service Reduction (WISeR) Model introduces prior auths for select services at risk of fraud, waste and abuse. … Read More
Shifts in federal policy may lead to more activity at the state level. Here some state bills seeking to regulate the use of AI in healthcare. … Read More
Providers are being ignored by contracted and non-contracted MA plans in their efforts to obtain a remedy for 340B drug underpayments. … Read More
A new corporate whistleblower program incentivizes reporting of healthcare fraud involving private insurance plans. … Read More
Many bills have been pending in state legislatures. Let’s take a look at what’s been recently enacted in three of those states. … Read More
State legislatures have already been busy this year. Here are some topics and bills Ensemble experts have been watching closely. … Read More
Health plans will be required to meet a prior authorization time frame as short as 72 hours, along with providing reasoning for any denials. … Read More
See how Ensemble is actually applying AI to drive value across the entire revenue cycle. … Read More
Federal agencies are scrutinizing Medicare Advantage coding with inaccurate diagnoses for enrollees with certain high-risk diagnoses. … Read More
The 2024 Medicare Advantage Final Rule clarifies that Medicare Advantage (MA) plans must follow the Two-Midnight Rule set in 2013, and more. … Read More