CMS’s 2026 OPPS final rule updates outpatient payment policies, adjusts 340B drug recoupment, extends site-neutral payment models, expands ASC services, and enhances hospital price transparency requirements effective January 2026.
CMS proposes extensive 2027 changes to Medicare Advantage and Part D, including Star Ratings overhaul and $14B spending increase. Insurers should assess impacts on quality bonuses and compliance.
CMS announces increases in Medicare Parts A and B premiums and deductibles for 2026, reflecting rising medical costs and usage. Explore implications for senior care, Medicaid, and insurance professionals.
Indian national sentenced to two years for Medicare fraud involving fake COVID-19 testing claims totaling over $1.17 million. The case highlights ongoing challenges in health care fraud detection and regulatory compliance.
The Medicare Diabetes Prevention Program has enrolled less than 1% of eligible beneficiaries since 2018 due to administrative, referral, and awareness challenges despite proven effectiveness. CMS changes aim to improve access and provider reimbursement.
Medicare's outdated reimbursement system is jeopardizing rural office-based medical practices by underpaying for advanced outpatient procedures, leading to consolidation and increased healthcare costs. Proposed reforms aim to preserve independent care and improve access.
CMS's 2027 Proposed Rule for Medicare Advantage revises Star Ratings by focusing on clinical quality and member experience, delaying equity-focused rewards, and enhancing integrated care for dual-eligible populations.
CMS introduces the ACCESS Model to enhance chronic care for Medicare beneficiaries using digital health tools and outcome-based payment models starting in 2026.
The Strengthening Medicare for Patients and Providers Act proposes indexing Medicare physician payments to the Medicare Economic Index to reflect economic realities and stabilize reimbursement.
Medicare Part D faces significant plan reductions and rising costs in 2026. Beneficiaries must review their drug plans before the December 7 deadline to avoid premium hikes and coverage losses.
