The Blue Cross Blue Shield Association submitted a wide-ranging letter to CMS on March 30 in response to the agency’s information request on its Comprehensive Regulations to Uncover Suspicious Healthcare, or CRUSH, initiative. Seven BCBSA recommendations: 1. CMS should notify…
Medicare Advantage
CMS published its final 2027 Medicare Advantage and Part D rule on April 2, enacting changes to star ratings, supplemental benefits administration, Part D coverage, and a series of deregulatory provisions. The rule is effective June 1 and applies to…
CMS awarded its Medicare Advantage independent review entity contract to C2C Innovative Solutions, according to a March 31 CMS letter published by the AMA. C2C secured the contract Feb. 26. Effective May 1, C2C will review appeals of adverse reconsiderations,…
CMS has granted Elevance Health’s request for more time to resolve the ongoing dispute over Medicare Advantage risk adjustment data reporting, pushing back a possible start date on enrollment sanctions by two months. In a March 18 statement, Elevance said…
A bipartisan group of four senators is advocating for stricter provisions under the proposed No Unreasonable Payments, Coding, or Diagnoses for the Elderly Act to address insurer upcoding, according to a March 30 letter sent to CMS Administrator Mehmet Oz,…
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Medicare Advantage now covers about 55% of eligible beneficiaries (about 35 million people) and costs the federal government a projected $76 billion more in 2026 than traditional fee-for-service Medicare would, according to a March report by the Medicare Payment Advisory…
For insurers that remain committed to their Medicare Advantage businesses, special needs plans have been a major growth driver. KFF estimated that almost half of MA enrollment growth from 2024 to 2025 stemmed from these tailored plans. In 2025, SNPs…
Pennsylvania has opened a special enrollment window for 5,400 UnitedHealthcare Medicare Advantage members affected by the contract dispute with Allentown-based Lehigh Valley Health Network, giving impacted beneficiaries until April 30 to switch plans. The state said March 16 that it…
HSS’ Office of Inspector General estimates that BCBS Alabama received at least $7 million in Medicare Advantage overpayments, according to a March audit report. From a sample of 271 enrollee-years, 247 had medical records that did not align with diagnosis…
About 82% of the more than 16,000 available public comments on the 2027 Medicare Advantage proposed rate notice share the perspective and language of a letter from the Medicare Advantage Majority, a group with undisclosed funding sources and founders, according…