Apprise MD

01/29/2026

President Trump’s Executive Order “Ensuring a National Policy Framework for Artificial Intelligence” may undo state laws about how hospitals can use AI. Read more here:

By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered: Section 1. Purpose.

01/22/2026

46% of health plan coverage denials were overturned following an external, independent medical review.
Read more here:

Nearly half of health plan coverage denials that reached independent medical review were overturned between 2019 and 2023, with significant variation by state, according to a Health Affairs study published Dec. 10. Researchers from the University of California San Francisco analyzed publicly availab...

01/19/2026

"Life’s most persistent and urgent question is, ‘What are you doing for others?’”
― Martin Luther King Jr.

MLK Jr. Day 2026"

01/15/2026

As of this month, MAOs should not be able to deny short-stay inpatient admissions ordered by a physician if the medical record supports an inpatient admission of two or more midnights and only the information available upon admission can be used to determine medical necessity. The CY 2026 rule negates a payer’s ability to deny coverage using information that arises during the hospital stay, holding the MA plans accountable for what they approve on day zero.
Read more at

Our MA & the Two-Midnight Rule Data Review paper examines a year of AppriseMD P2P data and reviews the Medicare population landscape and key UR review changes.

01/13/2026

A law restricting health insurance companies from using AI to alter provider codes that otherwise change the provider’s clinical judgment was introduced in New Hampshire. You can read more about this in the Becker's Healthcare article, "New Hampshire lawmakers introduce bills targeting AI-driven claims audits, telehealth parity," and then go to our website and download our paper The Use of AI in Claim Denials.

https://www.beckerspayer.com/policy-updates/new-hampshire-lawmakers-introduce-bills-targeting-ai-driven-claims-audits-telehealth-parity/

01/10/2026

Aetna’s Level of Severity Inpatient Payment Policy appears to be rooted in aligning payment levels more closely with clinical severity while also increasing consistency across facilities. Read more about this at https://apprisemd.com/understanding-aetnas-new-level-of-severity-inpatient-payment-policy/

01/08/2026

AppriseMD’s MA P2P data illuminate the importance of taking a consistent and aggressive approach to overturn denials. With 86% of the MA P2P denials demonstrating non-compliance with the Two-Midnight rule, hospitals need to ensure that every opportunity to overturn a denial is taken.

Read our paper, "A Closer Look," at https://apprisemd.com/medicare-advantage-two-midnight-rule-data-followup/

01/06/2026

Aetna’s Level of Severity Inpatient Payment Policy went into effect this month, introducing a new framework for evaluating and reimbursing urgent or emerging inpatient admissions. https://apprisemd.com/understanding-aetnas-new-level-of-severity-inpatient-payment-policy/

Hospitals and health systems are facing a significant shift in how Aetna reimburses certain inpatient stays with its Level of Severity Inpatient Payment Policy.

01/02/2026

After reviewing all 2024 P2P cases with MA payers, AppriseMD found that MAOs were compliant with the Two-Midnight rule in only approximately 14% of cases. In other words, based on the MA P2P data reviewed, MA plans were not compliant with CMS-4201-F in roughly 86% of initial determinations.

https://apprisemd.com/medicare-advantage-two-midnight-rule-data-followup/

Our MA & the Two-Midnight Rule Data Review paper examines a year of AppriseMD P2P data and reviews the Medicare population landscape and key UR review changes.

12/31/2025

Happy New Year from AppriseMD.

12/25/2025

Warmest wishes for a safe and happy holiday season from the team at AppriseMD.

12/23/2025

Read all our 2025 case studies at apprisemd.com/case-studies/