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A pilot program will start on 1/1 in several states to require preauthorization for several outpatient hospital services, DME and non-emergency ambulance transport in traditional Medicare. This is the start of an assault on the program. Also the preauthorization will be done by AI. The hospital services will be skin and tissue substitutes, electrical nerve stimulator implants, and knee arthoscopy. These are high cost items with skin substances costing about $10000 per square inch.
Wake up physicians. You are being paid 33.6% less for treating Medicare patients than you were 10 years ago. As bad as it is for you who do fee for service Medicare it is even worse for those of you who Medicare Advantage. The former is 10% lower and the latter is paid about 10%-15% less than those on traditional Medicare. Top
Kaiser continues to make a lot of money. In the second quarter 2025 they increased their operating income by $100 million over the prior year quarter to $1 Billion. Their operating revenue increased by $4 Billion, and their perating expenses also increased by $3 Billion. Their membership was over 13.1 million. Top
DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.