CMS is raising Medicare Advantage payments by 2.48%, or more than $13 billion, according to its finalized 2027 rate announcement. The agency said April 6 that when estimated risk score trends in MA are accounted for, the final rate amounts…
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As the Medicaid cuts from H.R. 1 begin to settle in, states are looking for workarounds to continue funding their programs. Iowa Republican Gov. Kim Reynolds signed a bill March 25 allowing a steeper HMO tax, which will also affect…
Ten providers recently posted job listings seeking leaders in payer contracting and relations. Note: This is not an exhaustive list. Listings were compiled from job-seeker sites. 1. Albany (N.Y.) Medical Center seeks a project manager of payer contracting and value-based…
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…
Payers are now required to publicly post certain prior authorization metrics, but an initial look at the first set of data offers “little insight into what gets approved or denied, according to an April 2 analysis from KFF. Five things…
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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…
Oregon Health Plan Bridge, the state’s basic health program, did not comply with income requirements, according to a March 31 audit from the Oregon Secretary of State. Auditors issued an adverse opinion of the program, which was implemented in July…
Healthcare has spent the last decade digitizing clinical and financial workflows. Transportation is one of the last major functions still operating without true infrastructure—and it is costing health plans more than they realize. Non-emergency medical transportation (NEMT) exists to solve…
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 issued a request for applications March 31 for its long-term enhanced ACO design model. The model’s performance period will span one decade — the longest CMS has tested — and run from Jan. 1, 2027, until Dec. 31, 2036.…