Compliance & Payment Integrity
Expert articles and analysis related to compliance & payment integrity.
AI Summary â Last 24 Hours
Synthesis:
In the past 24 hours, payment integrity and compliance tensions escalated as Jefferson Health and Lehigh Valley Physicians Hospital Organization filed suit against Aetna, alleging the insurer's Medicare Advantage downcoding policy violates federal law and contractual agreementsâan indicator of growing provider-payer strife over payment models and risk adjustment (Jefferson Health sues Aetna over Medicare Advantage payment policy). Simultaneously, CMS announced proposed payment updates for inpatient psychiatric and rehabilitation facilities, with rate increases below last year's final rules, signaling continued pressure on providers to manage costs while maintaining compliance in evolving VBC frameworks (CMS updates psychiatric and rehab payments).
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