10+ hour, 32+ min ago   (1095+ words) The agency quietly released a memo updating MA plans on how it's approaching risk adjustment data validation audits after a Texas judge's ruling last year complicated the expanded reviews. The CMS has provided a long-awaited update on how it plans…...

1+ day, 9+ hour ago   (351+ words) Nearly 53 million prior authorization requests were sent to insurers in 2024, compared with nearly 50 million in the prior year, according to KFF. Nearly all MA enrollees are subject to prior authorization " where providers have to receive an insurers" approval before offering…...

1+ week, 1+ day ago   (631+ words) Medicare director Chris Klomp said the Trump administration is "massively" in support of MA as health insurers cry foul over the meager'rate update. The Trump administration's top Medicare official is coming to the defense of the 2027 Medicare Advantage rate notice,…...

1+ week, 1+ day ago   (1024+ words) The Trump administration has taken a big step toward curbing Medicare Advantage overpayments, proposing a rule that would stamp out one strategy insurers use to inflate their members" sicknesses to get higher reimbursement in the privatized Medicare program. In a…...

2+ week, 5+ day ago   (1052+ words) The findings are "very depressing," one commissioner said. The federal government will pay an estimated $76 billion more to cover Medicare Advantage seniors this year than it would if those same seniors were in traditional Medicare, according to new estimates from…...

2+ week, 6+ day ago   (235+ words) The Justice Department claims some Kaiser health plans submitted invalid diagnostic codes to reap higher reimbursement from Medicare. In MA plans, the federal government reimburses private payers a fixed monthly amount for managing the care of seniors enrolled in their…...

3+ week, 2+ day ago   (896+ words) Staffers for Sen. Chuck Grassley, R-Iowa, dove into 50,000 pages of documentation from UnitedHealth for the new report, which accuses the company of maintaining a workforce dedicated to upcoding. UnitedHealth is aggressively gaming Medicare Advantage to inflate its reimbursement from the…...

4+ week, 9+ hour ago   (306+ words) The change'runs counter to the company's broader efforts'to pare back red tape for physicians amid widespread discontent with health insurers. Starting April 1,'when the same provider bills UnitedHealthcare for an E/M service and a global radiology code for the…...

4+ week, 2+ day ago   (401+ words) Don't miss tomorrow's healthcare industry news Why Star Ratings matter and what's at stake for health plans For health plans across the U.S., Star Ratings are more than just a score, they're a lifeline. These ratings, published annually by the Centers…...

1+ mon, 1+ week ago   (954+ words) On Friday, the healthcare behemoth released results of three highly anticipated external reviews that drilled down on a number of areas for improvement. UnitedHealth has pledged to make a range of improvements in response to the first outside reviews of…...