CMS and Insurers Launch AI-Driven Medicare Prior Authorization Reforms
CMS introduces WISeR model using AI to expedite Medicare prior authorizations while insurers enhance processes to cut waste and improve care approval speeds.
CMS Proposes Key Medicare Part B Pricing and Reporting Updates for 2026
CMS's 2026 proposed rules for Medicare Part B include major updates to average sales price calculations, Inflation Reduction Act compliance, ASP documentation, and Medicare inflation rebates affecting government pricing.
Eye Consultants of Pennsylvania Settles for $790K Over Medicare Billing Violations
Eye Consultants of Pennsylvania agrees to $790,000 settlement over False Claims Act violations involving Medicare E&M billing irregularities. Federal enforcement underscores commitment to Medicare compliance.
CMS Narrows Medicare Custody Definition to Expand Coverage Access in 2025
CMS finalized a 2024 rule narrowing Medicare custody to physical confinement, expanding Medicare coverage for community-supervised individuals starting 2025.
Medicare Advantage Plans: Key Drawbacks Affecting Coverage and Care
Explore the critical limitations of Medicare Advantage plans impacting provider access, prior authorization delays, and coverage costs, with insights relevant for healthcare and insurance professionals.
CMS Proposes 2.4% Medicare Payment Increase and New Two-Tier Physician Reimbursement Model for 2026
CMS proposes 2.4% Medicare payment increase for outpatient and surgery centers in 2026 with a new two-tier physician payment model to promote value-based care participation, amid concerns over long-term financial sustainability for providers.
Avoiding Lifetime Penalties in Medicare Part D Enrollment
Learn how to avoid lifetime Medicare Part D penalties by timely enrollment, understanding creditable coverage, and utilizing Extra Help financial assistance programs.
UnitedHealth Medicare Advantage Faces Lawsuits over AI Claims Denials
UnitedHealth Group faces lawsuits and federal probes over AI-driven claims denials in Medicare Advantage, highlighting regulatory risks and the need for ethical plan advisory.
DOJ-HHS Relaunches False Claims Act Working Group to Intensify Healthcare Fraud Enforcement
The DOJ and HHS have reestablished the False Claims Act Working Group to heighten enforcement of healthcare fraud, focusing on Medicare, Medicaid, pricing, and EHR compliance risks.
America's Physician Groups Advocate Accountable Care Relationships for Medicare Beneficiaries
Susan Dentzer of America's Physician Groups emphasizes accountable care relationships for Medicare beneficiaries to improve coordination, reduce hospitalizations, and support smaller practices.