ASCs face increasing delays and denials from payers impacting revenue cycles. Increased scrutiny on device/pharma claims and contract carve-outs prompt ASC contract renegotiations amid Medicare Advantage changes.

CMS introduces the WISeR Model pilot program leveraging AI-driven prior authorization to reduce Medicare overuse and fraud in six states from 2026-2031.

Starting in 2025, Medicare prescription drug plans will have a new $2,000 out-of-pocket cap under the Inflation Reduction Act, eliminating the donut hole and lowering costs for beneficiaries. This applies to both Part D and Medicare Advantage plans with drug coverage.

House GOP doctors outline reforms targeting Medicare fraud, PBM-driven drug costs, and graduate medical education funding to address Medicare insolvency and healthcare cost inflation.

Explore how Iowa's Medicaid and Medicare Savings Programs provide critical financial assistance for low-income Medicare beneficiaries, covering premiums, deductibles, and prescription drug costs.

UnitedHealth Group confirms DOJ investigations into Medicare billing and diagnosis code practices, impacting regulatory compliance and Medicare program integrity.

UnitedHealth Group is cooperating with federal investigations into its Medicare Advantage billing practices amid scrutiny over diagnosis-based payments. The insurer faces civil and criminal probes amid increased healthcare utilization and financial pressure.

UnitedHealth Group is under federal criminal and civil investigation for Medicare Advantage billing practices amid financial pressures and leadership changes. The company cooperates fully and maintains confidence in compliance.

CMS proposed 2026 Medicare payment rules expand digital health reimbursements, telehealth supervision flexibility, and update the Medicare Telehealth Services List.

Learn about Special Needs Plans (SNPs), Medicare Advantage plans tailored for individuals with chronic conditions or dual Medicaid eligibility, covering special benefits and care coordination.