Medicare

Decoding Medicare Advantage Coding Intensity

Federal payments to Medicare Advantage plans, and adjustments for health status, have come under increased scrutiny. This brief answers key questions about coding intensity, recent steps taken by CMS,...

Ensuring a Sustainable Medicare Program Through Effective Oversight

Ensuring a Sustainable Medicare Program Through Effective Oversight  JAMA

Medicare Advantage plans set to rake in $13B in 2026 quality bonus payments

Medicare Advantage plans set to rake in $13B in 2026 quality bonus payments  Fierce Healthcare

‘Medicare Advantage has never saved a penny’: Democrat-led bill seeks to rein in MA

‘Medicare Advantage has never saved a penny’: Democrat-led bill seeks to rein in MA  Becker's Hospital Review

Elevance Health sues CMS over MA star ratings recalculations

Elevance Health sues CMS over MA star ratings recalculations  Fierce Healthcare

Medicare Advantage Insurers Deny Prior Authorization Requests for Post Acute Care at Substantially Higher Rates Than the Overall Denial Rate

Two recent reports find that Medicare Advantage organizations deny prior authorization requests for long-term care hospital, inpatient rehabilitation hospital, and skilled nursing facility stays at hi...

Medicare Spending Projected To Continue Rising Through 2034; Medicaid & Private Insurance Growth To Slow - open minds

Medicare Spending Projected To Continue Rising Through 2034; Medicaid & Private Insurance Growth To Slow  open minds

CMS proposes increases to Medicare hospital outpatient department payment rates, site-neutral and 340B changes

CMS proposes increases to Medicare hospital outpatient department payment rates, site-neutral and 340B changes  American Hospital Association

CMS Releases CY 2027 OPPS Proposed Rule with IOP and PHP Rates

On Thursday, July 2, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year 2027 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Propose...

CMS Elicits Tempered Payment Optimism, Stokes Fraud Fears With Proposed Medicare Rule