Payment Integrity
Expert articles and analysis related to payment integrity.
AI Summary — Last 30 Days
CMS is tightening the payment-integrity frame around value-based care: the new 10-year ACCESS model has drawn 150+ applicants despite “lean” payments and voluntary participation, while CMS has halted the BALANCE model after low payer participation—signaling that CMMI under Abe Sutton is likely to favor models with clearer operational traction, scalable accountability, and lower federal outlay risk (ACCESS applicants). At the same time, Medicare Advantage risk-adjustment and utilization-management scrutiny is intensifying, with Aetna’s $117.7 million false
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