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Latest News & Web Pages
Medicare Advantage Agent and Broker Agreements: 2025 in Review
6+ min ago (135+ words) Major highlights from 2025 include the following: This blog post provides an introduction to agent/broker arrangements and describes recent enforcement trends, court cases, and agency guidance to help MA plans and other stakeholders navigate potential pitfalls and ensure compliance with…...
Medicare's three-day rule: Longer hospital stays, no patient benefit
43+ min ago (570+ words) A long-standing Medicare policy meant to manage rehabilitation services in nursing homes may keep older Americans in hospitals longer than necessary without improving patient health or saving Medicare money, new research finds. When the policy was created, typical hospital stays…...
From 1999 to Prime Time: OIG Revamps Medicare Advantage Guidance for Today’s—and Tomorrow’s—Evolving Market
45+ min ago (246+ words) The MA ICPG identifies seven compliance risk areas and provides recommendations to mitigate these risks. OIG continues to recognize, however, that compliance programs should be tailored to an MA Party's size, structure, and operations, rather than following a one'size'fits'all model....
CMS proposes to exclude unlinked diagnoses from Medicare Advantage risk adjustment: An opportunity for plan-provider value-based collaboration?
53+ min ago (451+ words) 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 D Payment Policies" on January 26, 2026, which included proposed changes related to…...
OIG Greenlights Cost-Sharing Waiver for Commercially Insured Patients
1+ hour, 26+ min ago (309+ words) On January 16, 2025, the U.S. Department of Health and Human Services Office of Inspector General (OIG) posted Advisory Opinion 26-01, offering clarity as to whether a manufacturer may waive patient cost-sharing amounts for certain insured individuals receiving its clinical diagnostic test without triggering…...
Looking for health insurance? Key differences between Medicare and Medicaid in 2026
1+ hour, 47+ min ago (403+ words) Understanding eligibility, coverage, and costs can help you choose the right program. As 2026 progresses, many Americans are exploring their health insurance options, particularly Medicare and Medicaid. While both programs provide coverage for millions of Americans, they serve distinct populations and…...
Medicare Advantage: New OIG Compliance Guidance Has Implications for Providers
4+ hour, 29+ min ago (303+ words) On February 3, 2026, the U.S. Department of Health & Human Services, Office of Inspector General (OIG), published the long-awaited Medicare Advantage Industry Segment-Specific Compliance Program Guidance (Medicare Advantage ICPG)." The Medicare Advantage ICPG is meant to identify risk areas for those engaging with…...
Medicare Advantage- New OIG Compliance Guidance Has Implications for Providers
6+ hour, 8+ min ago (268+ words) The Medicare Advantage ICPG is meant to identify risk areas for those engaging with or participating in Medicare Advantage, provide recommendations and practical considerations for mitigating those risk areas, and highlight other important information that the OIG believes parties should…...
The Ever-Shrinking Eldercare Workforce
6+ hour, 25+ min ago (800+ words) Without help, the supply of dementia care workers in the U.S. won't be able to keep up with an aging population. iStock (Model(s) used for illustrative purposes only) February 9, 2026 " By Undark and Cynthia Lien "I will take care of her to…...
Contributor: Reimagining Beneficiary Engagement in Accountable Care Models to Make America Healthy Again | AJMC
6+ hour, 38+ min ago (493+ words) Contributor: Reimagining Beneficiary Engagement in Accountable Care Models to Make America Healthy Again'The American Journal of Managed Care" (AJMC") Accountable care organizations (ACOs) nurture strong patient-provider relationships to provide high-quality, coordinated health care focused on prevention and chronic condition management....