Payer
患者权益组织PatientRightsAdvocate.org于周四起诉美国医学会，指控其对CPT计费代码的版权阻碍公众获取医疗计费信息，要求法院裁定代码进入公共领域。该组织称代码已被联邦和州法律引用，不应受版权保护。
A new Commonwealth Fund survey reveals that high insurance premiums and out-of-pocket costs are the dominant healthcare concerns for Americans across party lines and coverage types. While most favor federal government action, Republicans lean toward insurers as the solution.
KFF's analysis of first-ever public prior authorization metrics finds average denial rates of 12% in Medicare Advantage, 14% in Medicaid managed care, and 18% in ACA marketplaces, with wide variation among insurers. The data also reveals that appeals often succeed but are rarely pursued.
Fifth Circuit Overturns No Surprises Act QPA Methodology, Favoring Providers in Arbitration Disputes
The 5th U.S. Circuit Court of Appeals ruled on Tuesday that the federal methodology for calculating qualifying payment amounts (QPA) under the No Surprises Act is partly unlawful. The court sided with the Texas Medical Association and other plaintiffs on two of three challenges, finding that insurers improperly included 'ghost rates' and excluded bonus and incentive payments. The ruling is expected to raise provider payouts in arbitration, while the court allowed existing QPAs to remain temporarily to avoid disruption.
A Brookings Institution analysis contends that the CMS rule implementing Medicaid work requirements rests on 'complete random assumptions' with no empirical justification. The report challenges the agency's estimates that 29% of affected beneficiaries will find work, that only 3.1-3.3 million will lose coverage over a decade, and that the policy will save $350.3 billion — figures that diverge sharply from CBO forecasts and prior studies.