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CMS Proposed Rule Seeks to Provide Transparency and Efficiency in Preauthorization Process

INTRODUCTION - On 13 December 2022, the Centers for Medicare and Medicaid Services (CMS) published CMS-0057-P (the Rule),1 a proposed rule that, if adopted, will place new requirements on a number of entities, including...more

Surprise Billing Regulations: Impact on Out-of-Network Providers

On 1 July 2021, the United Stated Office of Personnel Management, and the Departments of the Treasury, Labor, and Health and Human Services (collectively, the Departments) issued an Interim Final Rule (the IFR) implementing...more

American Orthopedic — Third Circuit Addresses Anti-Assignment Clauses and Powers of Attorney in ERISA-Governed Health Insurance...

Recently, the U.S. Court of Appeals for the Third Circuit handed the insurance industry a small victory by holding that, in American Orthopedic & Sports Med. v. Indep. Blue Cross Blue Shield, unambiguous anti-assignment...more

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