Cole Medical Billing Inc

11/20/2025

Three major medical organizations are urging Anthem to withdraw a policy that would penalize hospitals and outpatient facilities that use out-of-network providers.

The three organizations said that policy would force hospitals to pressure independent providers to join Anthem's network "under unfavorable terms" and potentially shuffling providers to manage the policy could hinder continuity of care for patients.

"It effectively shifts Anthem’s network adequacy obligations onto facilities, holding them financially liable for the contracting status of independent physician groups—an area over which they have no control or infrastructure to manage," the groups wrote.

Elevance Health's Anthem plans are cracking down on hospitals or outpatient facilities that offer services using out-of-network providers. | Elevance Health's Anthem plans are cracking down on hospitals or outpatient facilities that offer services using out-of-network providers.

11/18/2025

The Valley Hospital is proud to announce that it has received reaccreditation from the American College of Surgeons (ACS) Commission on Cancer (CoC) Accreditation Program. The ACS CoC is a consortium of professional organizations focused on improving survival and quality of life for patients with cancer by setting and elevating standards. This honor reflects Valley's continued commitment to delivering high-quality, patient-centered cancer care.

This accreditation is awarded to institutions that meet more than 30 rigorous quality standards across the continuum of cancer services. It affirms Valley’s dedication to providing comprehensive, patient-centered care through multidisciplinary collaboration, evidence-based practices, and continuous quality improvement. To maintain accreditation, cancer programs must undergo a site visit every three years. The CoC accreditation standards supply the structure for providing all patients with a full range of diagnostic, treatment, and supportive services either on-site or by referral, including community-based resources.

“This accreditation is a testament to the dedication of our cancer care team,” said Ephraim Casper, MD, Chief Medical Officer of Valley-Mount Sinai Comprehensive Cancer Care and Chair of Oncology Services for Valley Medical Group. “Meeting these rigorous standards shows our commitment to delivering the highest quality of comprehensive and patient-centered care. We are proud to offer advanced cancer services close to home that meet our patients’ needs.”

To learn more about cancer services at Valley-Mount Sinai Comprehensive Cancer Care, please visit www.ValleyHealth.com/Cancer.

11/17/2025

The Centers for Medicare & Medicaid Services (CMS) revealed late Friday that total monthly premiums for Part B will be $202.90. By comparison, the premium for 2025 was $185. In addition, the deductible in Part B will rise to $283, up from $257 in 2025.

Medicare beneficiaries are set to see their Part B premiums rise significantly next year, according to an announcement from the Trump administration. | Medicare beneficiaries are set to see their Part B premiums rise significantly next year, according to an announcement from the Trump administration...

11/14/2025

"UnitedHealthcare has gobbled up our local healthcare practices, creating a monopoly that directly hurts everyone in our community,” Ryan, D-Gardiner, said in a statement. “Now, they’re telling a massive chunk of our community that they can’t access care at their Optum — but where else are people supposed to go?! In their greedy pursuit of profits, UnitedHealthcare owns the insurance company, they own your doctor and they own your pharmacy — and they use it all to keep prices high and drive quality down.”

KINGSTON, N.Y. — Health care provider OptumHealth will be dropping all Fidelis/Wellcare and Cigna/Healthspring insurance plans in-network in January 2026, according to the provider’s website.…

10/12/2025

When the shutdown started, Medicare said that MACs would hold claims for 10 days. If that is calendar days, the hold ended last Friday 10/10/25. If it is business days, and counting Columbus Day (tomorrow as a fed holiday), then the hold expires on Wednesday 10/15/25.

Existing laws and regs require that CMS pay Part B Medicare clean claims within 14 days.

So, CMS will have to inform us next week what instructions they will provide to the Medicare MACs.

10/06/2025

Atlantic Health, Saint Peter's University Hospital cancel planned partnership

Atlantic Health and Saint Peter's Healthcare System are pulling the plug on plans for a hospital partnership amid shifting health care trends.

10/04/2025

ASC’s have always been at the beck and call of surgeons, and that model is not likely sustainable if they don’t want to pay stipends.

More ASCs are turning to anesthesia stipends as workforce shortages deepen and coverage gaps threaten daily operations.  Christina Menor, MD, president-elect of the California Society of Anesthesiologists, joined Becker’s to discuss the sustainability of ASC anesthesia stipends and what alternati...

10/04/2025

Valley Health System has performed its first implant of Thoraflex Hybrid, manufactured by Terumo Aortic. The graft and stent hybrid is used to replace the diseased portion of the aorta in patients who have an aortic aneurysm or aortic dissection.

The Valley Hospital has performed its first implant of Thoraflex Hybrid, manufactured by Terumo Aortic.

08/30/2025

In the study published this week in Health Affairs, researchers from Georgetown University estimate that between 2022 and 2024, the IDR system cost $5 billion to manage. The largest chunk of that is the additional payments from plans to providers, totaling $2.24 billion.

While the arbitration process established under the No Surprises Act is designed to protect patients from unexpected, out-of-network charges, a new analysis finds that managing these disputes is pr | While the arbitration process established under the No Surprises Act is designed to protect patients...

08/29/2025

The official CMS CY 2024 win rate for clinicians is 85% in the No Surprises Act, with Q4 ‘24 IDR determinations coming in for docs and hospitals at nearly +460% of the initial payment.

UnitedHealthcare is suing Radiology Partners and its Arizona-based affiliate, Sonoran Radiology, alleging the companies have been “abusing” the No Surprises Act’s independent dispute resolution process and “funneling millions into the pockets of its private-equity owners.” The complaint, f...

08/26/2025

Johns Hopkins Medicine goes out of network with UnitedHealth Group.

Baltimore-based Johns Hopkins Medicine went out of network with UnitedHealthcare on Aug. 25 after the parties were unable to agree on a new contract The split comes after the two sides negotiated for eight months and extended their current agreement several times. Johns Hopkins said on its websi.....

08/08/2025

A little humor to close out the week.