Medicare Advantage 2027 updates boost payment updates near 5%, but risk rules and prior auth reforms force plans to rethink ...
If you read the memo and muttered, "uh-oh" under your breath, you might be thinking that your plan/organization owes CMS some money, and soon. If you haven't read this memo, "uh-oh" would be an ...
The Centers for Medicare & Medicaid Services (CMS) published its “Advance Notice of Methodological Changes for Calendar Year (CY) 2027 for Medicare Advantage (MA) Capitation Rates and Part C and Part ...
The Alliance of Community Health Plans is calling out risk adjustment scores by larger insurers in Medicare Advantage plans. ACHP, an organization that advocates for smaller health plans, said the ...
In late 2024, the Centers for Medicare and Medicaid Services previewed a significant revision to the risk-adjustment model that has long been considered by policy makers and researchers. This revision ...
After proposing near-flat payments, CMS reverses course with a roughly 5% effective increase for Medicare Advantage ...
CMS Launches Mandatory Two-Sided Risk Model for Specialists Treating Heart Failure and Low Back Pain
On October 31, the Centers for Medicare & Medicaid Services (CMS) finalized the Ambulatory Specialty Model (ASM), a mandatory alternative payment model (APM) for select specialists who regularly treat ...
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Report: UnitedHealth Group used 'aggressive tactics' in Medicare Advantage risk assessments
UnitedHealth Group used aggressive tactics to maximize it's Medicare Advantage risk adjustment scores, a new report alleges. The U.S. Senate Committee on the Judiciary published its majority staff ...
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