4+ hour, 5+ min ago  (498+ words) The CMS pushed back sanctions until July 1 after Elevance made progress on fixing faulty data submissions for its privatized Medicare plans. Earlier this year, the CMS alleged that Elevance, a major player in privatized MA plans, failed to submit data…...

4+ mon, 2+ day ago  (458+ words) Companies are hoping to reshore finances and double down on efficiency initiatives this year as several policy sea changes threaten to upend the industry. The healthcare industry is reckoning with a litany of challenges heading into 2026. Major policy revisions, technological…...

1+ week, 4+ day ago  (788+ words) Physician pay hasn't kept up with the costs of providing care, pushing independent practices to sell to health systems and likely increasing costs, lawmakers and witnesses said. Physician pay has declined over the past two decades when accounting for inflation,…...

1+ week, 5+ day ago  (355+ words) Lawmakers introduced a resolution to end the WISe R model, which Democrats say is delaying and denying care to seniors. The program, called the Wasteful and Inappropriate Service Reduction model, was announced by the CMS last summer as part of…...

2+ week, 3+ day ago  (410+ words) The effort, part of the agency's ambitious Health Tech Ecosystem, aims to accelerate the industry's progress before requirements on electronic prior authorization go into effect next year. Prior authorization, where clinicians have to receive approval from insurers before offering certain…...

2+ week, 4+ day ago  (485+ words) Only 33% of physicians surveyed by the American Medical Association said they believed voluntary pledges made by insurers last year to reform prior authorization would result in meaningful difference. Physicians have long criticized prior authorization practices, a cost-control measure used by…...

1+ mon, 4+ day ago  (492+ words) Insurers say that prior authorization, which requires patients and their physicians to request coverage for a service before it's provided, is an important tool for making sure that their members receive proper and cost-effective care. Anecdotal reports from physicians'suggest that…...

1+ mon, 1+ week ago  (513+ words) The report compiled by Sen. Maria Cantwell, D-Wash. , found procedures that were previously approved within around two weeks now take four to eight weeks to be authorized. The pilot, called the Wasteful and Inappropriate Service Reduction model, was announced by…...

1+ mon, 1+ week ago  (1344+ words) Elevance expects it'll have to pay the CMS around $935 million this year due to faulty MA data reporting. Elevance on Wednesday became the second major insurer to raise its 2026 earnings guidance on the back of better-than-expected first quarter results " though,…...

10+ mon, 2+ week ago  (1029+ words) The proposed rule would send an additional $8 billion to hospitals next year, but includes a number of other policies hospital groups have criticized. Hospitals could get $8 billion more in Medicare reimbursement for outpatient services next year under a new proposed…...