CMS to implement the WISeR Model in 2026, using AI tools for prior authorization in traditional Medicare, aiming to streamline utilization management and control costs.
Medicare in 2026 will see notable premium hikes, fewer prescription drug plans, and changes in Medicare Advantage availability. Understand the impact on coverage choices and costs to prepare for open enrollment.
CMS will end the kidney care payment model early and adjust Medicare home health reimbursements in 2026. A new 10-year program supports tech adoption for chronic disease management.
The federal government lowers obesity drug prices and expands Medicare coverage, impacting millions of patients and primary care providers with new access and cost structure.
The Centers for Medicare & Medicaid Services renews Quest Analytics contract to enhance Medicare Advantage network adequacy reviews and compliance oversight for better access to care.
A new Medicare pilot program using AI for claims review will launch in six states, including Arizona, sparking provider concerns over care denials and increased administrative processes.
Explore how the U.S. prospective most-favored-nation (MFN) pricing strategy aims to lower drug prices while preserving pharmaceutical innovation and encouraging fair global contributions to R&D funding.
Explore five strategic healthcare reforms proposed to cut costs across the U.S. healthcare system and enhance affordability in insurance and care delivery.
Local Medicare forums in Carroll County, NH address widespread Medicare Advantage plan cancellations. Insurance agent-led discussions help seniors navigate transitions and compliance.
CMS cuts Medicare home health reimbursement by $220M in 2025, less than the proposed $1B reduction. Providers highlight sustainability concerns under current payment model.
