News
CMS benches BALANCE Model for Medicare
20+ hour, 7+ min ago (915+ words) Ca-ssis/istock via Getty Images CMS is no longer moving forward with the Medicare Part D component of the Better Approaches to Lifestyle and Nutrition for Comprehensive h Ealth, or BALANCE, Model, according to a memo sent on Tuesday. Announced…...
Major payers say they cut prior authorizations by 11%
2+ week, 1+ day ago (808+ words) Leading healthcare payers said they have pared back prior authorizations after taking a pledge last year to simplify the notoriously cumbersome process. America's Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association (BCBSA) reported yesterday that participating payers…...
Insurers get a 2. 48% MA pay bump after close call with a flat rate
2+ week, 3+ day ago (662+ words) Plans participating in Medicare Advantage will get a larger payment increase than originally planned, according to the finalized 2027 Rate Announcement. Yesterday, CMS released the rate announcement for Medicare Advantage (MA) capitation rates and Parts C and D payment policies for…...
CMS proposes Medicare payment rules for SNFs, 3 others
2+ week, 3+ day ago (1050+ words) Christian Delbert - stock. adobe. CMS has proposed Medicare payment updates for four types of provider organizations, including skilled nursing facilities. On April 2, the federal agency released four proposed payment rules for skilled nursing facilities (SNFs), hospices, inpatient rehabilitation facilities (IRFs)…...
Aetna to pay $117. 7 M to settle Medicare Advantage false claims case
1+ mon, 1+ week ago (582+ words) Aetna has agreed to pay $117. 7 million to resolve allegations that it violated the False Claims Act by submitting inaccurate or untruthful diagnosis codes for its Medicare Advantage Plan enrollees, according to a Department of Justice press release. The alleged practice…...
Report: Medicare Advantage growth gives way to SNPs
1+ mon, 3+ week ago (593+ words) Christian Delbert - stock. adobe. Medicare Advantage enrollment growth is continuing its downward trend, with new Chartis numbers showing enrollment grew only 2. 5% this year, compared to the 3. 6% seen in 2025 and the historic 7% growth in the early 2020s. All said, Medicare Advantage enrollment…...
Nearly 45% of healthcare payments tied to APMs: Survey
2+ mon, 2+ week ago (503+ words) Andrey Popov/istock via Getty Ima Health plans remain committed to value-based care, with both public and private payers funneling dollars to alternative payment models, according to a new survey from America's Health Insurance Plans. This year, AHIP continued the…...
Orgs with more MA patients face more readmission penalties
2+ mon, 3+ week ago (570+ words) Yuichiro Chino/Moment via Getty Does the Hospital Readmissions Reduction Program penalize hospitals that treat a bigger Medicare Advantage population? Perhaps, according to a report in JAMA Network Open. The Hospital Readmissions Reduction Program (HRRP) was launched in 2012 to measure…...