Premier Medical Appeals

Premier Medical Appeals Premier Medical Appeals seeks to partner with hospitals, physicians and other healthcare providers to safeguard revenue.

We recognize that the profit margin for the healthcare provider has contracted and that every reimbursement is important. Premier Medical Appeals has an experienced staff of highly trained clinical personnel. This team is capable of navigating the unique and often complex payer requirements that must be met in order to receive reimbursement for services. Our expertise is in developing an appeal response to all types of payer denials.

10/29/2025

Axios (10/28) reports a study by KFF found that “Medicare Advantage enrollees on average had access to just under half (48%) of the physicians in their area who were available to people enrolled in traditional Medicare in 2022.” According to the study, “one-fifth of Medicare Advantage enrollees in plans with the narrowest networks had in-network access to about one-third of all physicians who were available to people in traditional Medicare. On the other side, the one-fifth of MA enrollees in plans with the broadest networks had access to more than two-thirds of physicians available to beneficiaries in traditional Medicare.”

10/23/2025

Bloomberg (10/21, Tozzi, Subscription Publication) reports UnitedHealth Group is “testing a new system to streamline how medical claims are processed, an early example of what the company says is the potential for artificial intelligence to smooth out friction in billing. The system, dubbed Optum Real, aims to distill health plans’ complex rules around what is covered into information that doctors and billing staff can use in real time to tell whether a claim is likely to be paid.” The system has been used “at Allina Health, a 12-hospital system based in Minneapolis, since March, where two departments have used it to connect to UnitedHealthcare, the health conglomerate’s insurance division. It’s already reduced claims denials meaningfully across more than 5,000 visits in Allina’s outpatient cardiology and radiology departments, said Dave Ingham, chief digital and information officer for the hospital group.”

10/03/2025

Bloomberg Law (10/2, Belloni, Subscription Publication) reports that rural hospitals “facing financial headwinds and frustrated with prior authorization demands are withdrawing from contracts with Medicare Advantage plans, prompting concerns from insurers that the cancellations could have consequences for patients.” According to Bloomberg Law, “over 25 hospitals across the country have decided to pull out of some or all of their Medicare Advantage contracts since Jan. 1. Industry groups such as the American Hospital Association cite MA’s lower reimbursement, more aggressive prior authorization, and increased administrative demands when compared with traditional Medicare as reasons behind the contract closures.” Most of the cancellations “have come from Medicare Advantage plans from large national insurance firms such as Anthem Blue Cross Blue Shield, Aetna, Humana, and UnitedHealthcare.”

09/27/2025

Forbes (9/25, Japsen) reports an analysis by the Urban Institute estimates that “hospitals, physicians and other medical care providers will lose more than $32 billion in revenue next year” if Congress “doesn’t extend tax credits for those with individual coverage under the Affordable Care Act.” In addition to the billions in lost revenue in 2026, “hospitals would also see a $7.7 billion increase in ‘uncompensated care,’ which are services these medical care providers must deliver but aren’t reimbursed for by government and private insurers, the Urban Institute report said.”

08/15/2025

Healthcare Finance News (8/13, Lagasse) says a new report found that 88% of “health systems are using artificial intelligence internally, but just 18% have a mature governance structure and fully formed AI strategy.” Analysts at the Healthcare Financial Management Association and market research company Eliciting Insights noted that “governance is lacking despite the fact that 71% of survey respondents have identified and deployed pilot or full AI solutions in finance, revenue cycle management or clinical functional areas.” According to the report, “nearly 80% of health systems say an existing vendor, or a firm partnered with an existing vendor, would have a significant advantage over a new vendor looking to pilot AI. And 70% of health systems say they would be more comfortable sharing data to power AI models with existing vendor partners.”

08/13/2025

KFF Health News (8/12, Zionts) reports, “Emergency medicine researchers and providers believe ERs, especially in rural areas, increasingly operate with few or no physicians amid a nationwide shortage of doctors.” One study published in JACEP Open “found that in 2022, at least 7.4% of emergency departments across the U.S. did not have an attending physician on-site 24/7.” Over “90% were in low-volume or critical access hospitals – a federal designation for small, rural hospitals.” Some physicians “and their professional associations say physicians’ extensive training leads to better care, and that some hospitals are just trying to save money by not employing them.”

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Tuesday 8:30am - 5pm
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