BCBS NC buys all NC FastMed locations
Plus: CMS says payers need to speed up prior authorizations
Good morning and happy Friday. This is the Friday Pulse Check from Fulcrum Strategies.
In the news:
CMS issues new rule to speed up prior authorization requests
The new rule, finalized on Wednesday, requires payers that sell Medicare, Medicaid, CHIP, and Obamacare plans to turn around urgent prior authorization requests within seventy-two hours and all others within seven days. While it is good that the Biden Administration is trying to help patients and providers navigate the confusing and often problematic prior authorization process, it is not clear what the enforcement mechanism will be. It is also possible that the increased time frame for processing authorizations will cause a more relied-upon use of AI systems by the payers. Those systems are now the cause of lawsuits for organizations such as Cigna and UnitedHealthcare. Read more from the Centers for Medicare and Medicaid Services.
Drug manufacturers’ co-pay assistance now counts toward deductibles
After the Biden administration withdrew its appeal of a September ruling by the U.S. District Court for the District of Columbia, insurance companies must count co-pay and co-insurance payment assistance from the drug companies as part of a patient’s deductible. Previously, insurance companies were not required to count payment assistance programs as counting towards a patient’s deductible. Read more in STAT News. 🔒
BCBS NC seals the deal on FastMed locations
BlueCross BlueShield North Carolina, a non-profit licensee of the BlueCross BlueShield Association, has purchased all of the North Carolina locations of the primary care and urgent care chain FastMed. Previously, it had held a minority stake in the company since 2012. BCBS NC says it will continue to see all patients, not just BCBS NC members. Read more in Becker’s Payer Issues.
Other articles of interest
The FLATLINING Podcast from Fulcrum Strategies
This week on the podcast, Ron and I discussed a new website from the Pennsylvania state Department of Insurance that allows patients to appeal claims their health insurer has denied.
Who is eligible to appeal a claim
What are some of the pitfalls are of such a system
What, if any, are the repercussions insurers face for improperly denying claims
Or listen on YouTube:
Who was the most excited person in sports last weekend? Probably Dan Miller on the Detroit Lions Radio Network. Here are the final calls of the Lions/Rams game.
Lions take on the Buccaneers Sunday at 3pm on NBC and Peacock.
Have a good week and GO LIONS!