HHS OIG Identifies Errors in NGS Medicare Cost Report Desk Reviews
HHS OIG finds widespread errors in Medicare cost report desk reviews by NGS and recommends enhanced reviewer training and procedures to improve audit accuracy and compliance.
TeamHealth’s TeamACO Cuts Medicare Post-Acute Costs by $15.8M in 2024
TeamHealth’s TeamACO reduces Medicare post-acute care costs by $15.8M in 2024 through readmission reductions and value-based care strategies across 33 states.
CMS Delays Medicare Advantage Supplemental Benefit Reminder Rule Until 2026
CMS delays the Medicare Advantage rule requiring midyear reminders about unused supplemental benefits to 2026, addressing insurers' readiness and data tracking challenges.
Medicare Enrollment Guidance for HR Managing Employees Over 65
Key Medicare enrollment rules for HR managing employees over 65 with employer health benefits. Guidance on timing, documentation, and regulatory compliance to avoid coverage gaps.
Medicare Quality Programs Under Scrutiny: Calls for Supportive Reform
Medicare's pay-for-performance programs face criticism for inefficacy and inequity. Experts advocate shifting to supportive models rewarding incremental improvement and incorporating patient-reported outcomes to enhance quality care.
CMS Launches AI-Driven Prior Authorization Pilot for Traditional Medicare in Washington
CMS to start AI-driven prior authorization pilot for traditional Medicare in Washington and five other states in 2026, targeting low-value procedures to reduce waste and improve compliance while maintaining clinician oversight.
Algorithms Enhance Fairness in Medicare Advantage Risk Adjustment Payments
New algorithmic approaches improve fairness in Medicare Advantage payment models, promoting equitable spending for minority beneficiaries without reducing predictive accuracy.
Birmingham VA Health Care System Achieves 5-Star CMS Rating in 2025
The Birmingham VA Health Care System earned a 5-star rating from CMS in 2025, ranking among the top medical centers nationwide for Veteran health care quality and safety.
CMS Extends and Enhances AHEAD Model to Advance Cost Control and Prevention
CMS extends the AHEAD Model to 2035, introducing payment reforms and transparency to improve Medicare cost control, prevention, and population health outcomes.
Medicare Advantage's Growth Shifts Coverage Landscape for Retirees
Explore how Medicare Advantage's growth reshapes retiree coverage, employer health benefits, and taxpayer costs amid evolving Medicare policy and enrollment trends.