Friday, June 5, 2026

HHS finalized a rule to streamline Federal Independent Dispute Resolution operations for out-of-network claims under the No Surprises Act. The update refines the administrative process and timelines for providers and payers contesting payment amounts for out-of-network emergency and non-emergency services at in-network facilities. For practices, this means the IDR portal interface and submission deadlines for new disputes will shift; the effective date is pending, but changes are expected within 90 days. Review the new HHS guidance and brief staff handling out-of-network claim disputes.

The latest AMA prior authorization survey indicates promised payer reforms are not materializing at scale. Over 90% of physicians report care delays due to PA, with 33% saying the process has worsened over the past year. The survey singles out UnitedHealthcare, Aetna, and Cigna for maintaining complex, manual processes that increase administrative costs. The operational impact: more staff hours per week diverted to chasing authorizations, particularly for advanced therapies in IBD, cardiology, and oncology. Monitor your primary payers' PA portals for any announced simplification; no immediate action is required but expect denials for missing or delayed PAs to continue rising.

The Centers for Medicare & Medicaid Services published final Medicaid work requirements. Enrollees aged 19-64 must document 80 hours of work, community service, or education monthly. Medical frailty exemptions are tightened; patients must prove they qualify. States can begin implementing immediately. This is a structural eligibility shift that will reduce Medicaid rolls and increase administrative burden on practices to verify patient coverage status. The comment period for the rule has closed; the policy is now effective. Monitor your state Medicaid agency's implementation timeline and prepare for patient eligibility inquiries.

The House-passed Federal One Big Beautiful Bill Act (H.R. 1) proposes deep cuts to federal healthcare funding that state officials warn will force rural hospital closures. The bill reduces support for rural healthcare programs and Medicaid. One-third of Virginia's rural hospitals are already at risk of closing, a crisis lawmakers directly attribute to federal funding instability. If the Senate passes similar cuts, referral networks for independent practices will contract, patient travel distances will increase, and local economies will lose anchor employers. Track the Senate's version of H.R.1; the final conference report will determine the scale of cuts.

A survey commissioned by the American Hospital Association found 21% of privately insured adults had a claim or prior authorization denied in the past year. Among those, over half reported the denial led to delayed or foregone care. The data underscores a persistent friction point for billing teams: increased appeal volumes and patient complaints when payers reject doctor-recommended treatments. While the survey does not name specific payers, it signals that denial rates remain high across commercial plans, reinforcing the need for robust internal tracking of denial reasons by payer and service line.