Supporting Our Clients Against MA Plans’ 340B Inequities
Providers are being ignored by contracted and non-contracted MA plans in their efforts to obtain a remedy for 340B drug underpayments. … Read More
November 13, 2024
Regulatory Updates
Ideas, insights + industry updates
Whistleblower Program Incentivizes Reporting of Healthcare Fraud
A new corporate whistleblower program incentivizes reporting of healthcare fraud involving private insurance plans. … Read More
September 30, 2024
Tracking Recently Enacted State Laws That Impact the Revenue Cycle
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
July 29, 2024
Revenue Cycle Impacts: 2024 State Legislation
State legislatures have already been busy this year. Here are some topics and bills Ensemble experts have been watching closely. … Read More
April 30, 2024
CMS Tightens Prior Authorization Time Frame in Final Rule
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
January 30, 2024
Ensemble’s AI Impact
See how Ensemble is actually applying AI to drive value across the entire revenue cycle. … Read More
January 16, 2024
OIG Increases Scrutiny on Medicare Advantage Coding
Federal agencies are scrutinizing Medicare Advantage coding with inaccurate diagnoses for enrollees with certain high-risk diagnoses. … Read More
October 27, 2023
Clarification of the Two-Midnight Rule: A Win for Physician Advisory
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
October 25, 2023
Congress Investigates OIG Report That Medicaid MCOs Deny Prior Authorizations at Higher Rates
A report from the OIG found some MCOs have unusually high rates of prior authorization denials, with limited or no state oversight. … Read More
October 3, 2023
2024 Medicare Advantage Program Changes: What You Need to Know
This new rule introduces several key changes that will promote transparency and consistency in healthcare coverage decisions. … Read More
July 18, 2023