January 2026

Nurse checks on infant in hospital

Case Study: Infant Failure to Thrive Inpatient Denial Overturned

Case Study, Medicaid, Peer-to-Peer / By

CLINICAL SUMMARY: A newborn infant, just over one-month-old, arrived at the Emergency Department (ED) under the direction of a pediatrician, who was concerned about lack of weight gain since birth. The infant was born weighing 8 pounds, 5 ounces and weighed 8 pounds, 5.5 ounces one month and five days after birth. The patient’s weight […]

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payment policy for hospitals balancing cost and care

Understanding Aetna’s New Level of Severity Inpatient Payment Policy

Blog, Payers / By

Hospitals and health systems across the country are preparing for a significant shift in how Aetna reimburses certain inpatient stays. Aetna’s Level of Severity Inpatient Payment Policy, which went into effect January 1, 2026, (updated from the original effective date of November 15, 2025) introduced a new framework for evaluating and reimbursing urgent or emerging

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