Aetna has announced a delay to its new inpatient reimbursement policy, now set to take effect in January 2026, with a narrower scope of claims impacted. While this delay gives hospitals more time to prepare, the policy still poses meaningful financial and operational risks once implemented.
According to the Healthcare Financial Management Association (HFMA),
“The policy has raised concerns that hospital billing systems are unprepared to flag the downgrades for a possible appeal. The payment change from inpatient to observation would not show up as a denial, meaning hospitals might overlook the reimbursement reduction.”
What the Policy Means for Hospitals
Aetna’s new approach would reclassify certain inpatient hospital stays as outpatient “observation” cases, resulting in lower reimbursements for hospitals and increased administrative complexity. Even with the delayed start date, hospitals face several challenges:
- Unflagged downgrades could lead to missed appeal opportunities and unnoticed revenue loss.
- Shifting payer rules require ongoing monitoring to ensure accurate billing and coding.
- Increased manual workload for revenue cycle teams already managing high denial volumes.
In short, hospitals will need better visibility and faster response mechanisms to mitigate potential revenue leakage when the policy takes effect.
How Adonis Helps Hospitals Stay Ahead of Policy Changes
Constant payer policy shifts like this highlight a growing challenge in healthcare revenue operations, the lack of transparency into payer behavior.
Adonis provides hospitals and health systems with real-time visibility into payer reimbursement activity, empowering teams to act immediately through Adonis Intelligence and AI Agents. The platform surfaces downcoding, underpayments, and emerging denial trends before they impact cash flow, allowing hospitals to respond proactively, protect margins, and safeguard revenue.
By connecting data across the revenue cycle, Adonis ensures that provider organizations aren’t caught off guard by policy changes like Aetna’s. Instead, they’re positioned to anticipate payer actions, streamline appeals, and sustain predictable financial performance.
Read the full story from HFMA: Aetna Delays and Modifies New Policy That’s Set to Affect Reimbursement for Inpatient Hospital Stays
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