2+ week, 1+ day ago  (493+ words) Senators praised a recent CMS proposal aimed at reducing payments in MA, but urged the agency to work with Congress and go further. MA, where the federal government contracts with private insurers to manage the care of Medicare seniors, has…...

3+ day, 9+ hour ago  (680+ words) Regulators are proposing to send $1. 4 billion more to acute care hospitals and debut the first nationwide, mandatory payment model to lower the cost of joint replacements. Hospitals pushed back. Medicare on Friday proposed to increase net payment rates for inpatient…...

1+ week, 3+ day ago  (223+ words) It's the'latest in a flurry of executive appointments from health insurers looking to strengthen their leadership teams amid regulatory headwinds and elevated medical costs. Centene is the largest insurer in both the Medicaid and ACA markets, with its almost 28 million…...

1+ week, 6+ day ago  (1008+ words) Regulators cut almost a dozen metrics that factor into the quality ratings and reverted back to an older and more generous bonus system. The Trump administration has finalized a rule overhauling the Medicare Advantage star ratings system that's expected to…...

1+ week, 1+ day ago  (277+ words) The health system claims the policy, which reduces reimbursement for some inpatient hospital stays, violates federal law and its reimbursement contract with Aetna. Aetna says its new policy, which went into effect at the start of the year, is meant…...

1+ week, 2+ day ago  (322+ words) Last summer, major payers committed to pare back onerous prior authorization policies, to the skepticism of the provider industry. Now, AHIP and the BCBSA are providing an update. The move was heralded by the industry and by regulators in the…...

1+ week, 2+ day ago  (1123+ words) Regulators locked in a 2. 48% average rate hike for next year, much higher than the 0. 09% that was originally proposed. The Trump administration finalized significantly higher Medicare Advantage rates for 2027 than it had proposed after a full-court lobbying press from the insurance…...

2+ week, 1+ day ago  (348+ words) The insurer had until the end of March to correct faulty data submissions or be hit with severe sanctions from the CMS. But regulators agreed to give Elevance more time to comply. Regulators informed Elevance of the impending sanctions in…...

4+ week, 1+ day ago  (1455+ words) CEO John Kao lays out how he sees his company breaking away from the pack. Kao established Alignment Healthcare in 2013, with the goal of creating an MA model laser-focused on clinical care by combining advanced data analytics with personalized attention,…...

1+ mon, 5+ day ago  (698+ words) Congressional investigators found Medicare Part B premiums rose by more than $200 per member, totaling $13. 4 billion in additional spending, due to the alleged overpayments. Medicare Advantage was created in the late 1990s to save taxpayers and Medicare beneficiaries money and improve care…...