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Court Dismisses Aetna Lawsuit Over Radiology Billing Dispute

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A federal judge in the U.S. District Court for the Middle District of Florida has dismissed a lawsuit brought by Aetna against radiology providers, marking a notable development in disputes tied to the No Surprises Act. The case centered on allegations that Radiology Partners and Mori, Bean and Brooks leveraged the law’s independent dispute resolution (IDR) process to secure higher reimbursements on out-of-network claims. According to court filings, Aetna argued that tens of thousands of…
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Integrating Psychological Care to Improve Patient Outcomes

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As healthcare continues to move toward whole-person, value-based care, integrating psychological support into treatment plans is becoming increasingly essential—particularly for patients undergoing high-stress interventions such as oncology care, chronic disease management, and in-vitro fertilization (IVF). Research shows that psychological distress is not a secondary concern but a core clinical factor that directly impacts treatment adherence, decision-making, and overall outcomes. Embedding psychologists within care teams allows providers to proactively address stress, rather than treating it as…
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CMS Proposes Expanding Prior Authorization Rules to Include Prescription Drugs

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The Centers for Medicare & Medicaid Services (CMS) has introduced a proposed rule that would extend its prior authorization interoperability framework to prescription drugs for the first time, building on its earlier efforts focused on medical services. Key Highlights for Providers: Resource: CMS proposes extension of prior authorization rule to cover drugs: 6 notes

Alabama Healthcare Update: Veteran Recognition, Workforce Leadership, and Rural Funding Pressures

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Veteran Care & RecognitionAndalusia Health has become the first hospital in Alabama to receive designation as a Purple Heart Hospital, recognizing veterans who were wounded or killed in combat. The facility is implementing visible and ongoing initiatives—such as dedicated signage and recognition programs—to better honor and support veteran patients within its care environment. Healthcare Education & WorkforceThe University of Alabama at Birmingham (UAB) continues to strengthen its national reputation, with its Master of Science in…
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New Index Reveals Widespread Mental Health Coverage Gaps Across 43 States

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A new Mental Health Parity Index—developed by organizations including the American Medical Association—highlights ongoing disparities between mental and physical healthcare access across the U.S., despite existing parity laws. Built using transparency data from the Centers for Medicare & Medicaid Services (CMS), the tool analyzes payer networks, reimbursement, and access to care. Its findings show that 43 states still face significant gaps in access to in-network mental health and substance use disorder services. Key Trends Identified:…
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CDC Data Highlights Decline in Respiratory Illnesses, but Ongoing Risks for Children

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New data from the Centers for Disease Control and Prevention (CDC) shows a broader decline in respiratory illnesses across the U.S., but serious concerns remain—particularly for pediatric populations. This flu season has been especially severe for children, with 139 pediatric deaths reported, including a recent weekly increase. Notably, the majority of these cases involved unvaccinated children, reinforcing the role of immunization in preventing severe outcomes. Overall, the U.S. has seen at least 31 million flu…
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CMS Releases Final HCPCS Level II Coding Decisions for Q1 2026

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The Centers for Medicare & Medicaid Services (CMS) has published its final determinations for the HCPCS Level II Q1 2026 coding cycle, providing important updates for providers, suppliers, and billing teams. This release includes new codes, revisions, and other coding decisions that may directly impact claims submission and reimbursement. Each decision is supported by detailed documentation outlining the coding issue, a summary of the original request, and CMS’ final determination—giving providers helpful context behind each…
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Humana in Focus: Leadership Changes, Legal Challenges, and Strategic Growth

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Humana has made a series of notable moves in recent months, reflecting shifts in leadership, ongoing legal activity, and continued expansion efforts. On the leadership front, the company appointed Bobby Mukundan as senior vice president and chief technology officer, while Robert Field joined its board of directors—signaling a focus on technology and strategic oversight. Legal challenges remain an area to watch. Humana is involved in multiple lawsuits, including allegations tied to antitrust activity with Zelis…
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Study Questions CMS “Topped-Out” Measure Designations in MIPS

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A recent study published in Health Affairs Scholar is raising concerns about how the Centers for Medicare & Medicaid Services (CMS) evaluates quality performance under the Merit-based Incentive Payment System (MIPS). Between 2017 and 2023, nearly half of MIPS quality measures were labeled as “topped out”—a designation typically used when performance is consistently high and improvement opportunities are considered limited. However, the study found that many of these measures were reported by only a small…
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Labcorp Launches Rapid Fentanyl Test for Clinical Settings

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Labcorp has introduced a new rapid diagnostic tool designed to detect fentanyl exposure in clinical environments. The Fentanyl Urine Visual Test, recently cleared by the U.S. Food and Drug Administration, can identify fentanyl use within a 48-hour window and delivers results in approximately 10 minutes. Built for use in emergency departments, hospitals, and clinics, this test aims to support faster clinical decision-making in situations where timely detection is critical. Its quick turnaround may help providers…
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CMS Issues Key Coding & Payment Updates Across Cardiac Devices, Wellness Visits, and Lab Services

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The Centers for Medicare & Medicaid Services (CMS) has released several targeted updates impacting coding, coverage, and payment policies—areas providers should review to ensure accurate billing and planning. Cardiac Contractility Modulation (CCM) – Heart FailureCMS added new guidance tied to HCPCS codes C1824, C1898, and K1030, signaling updates for providers managing patients with heart failure using CCM devices. These changes may affect how related procedures and supplies are reported and reimbursed. Annual Wellness Visit (AWV)Updates…
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