CMS extends the Medicare off-cycle revalidation deadline for skilled nursing facilities to January 1, 2026, maintaining the existing requirements. Providers should prepare to comply to avoid Medicare participation disruptions.
Explore how CMS's Medicare Advantage Star Rating system's opaque methodologies create regulatory arbitrage and financial risks for insurers like Elevance Health, Humana, and UnitedHealthcare, shaping the healthcare insurance landscape.
Texas federal judge rules against Elevance Health in lawsuit over Medicare Advantage star ratings, impacting $375 million in bonus revenue. CMS methodologies upheld.
CMS proposes a 6.4% cut in 2026 Medicare payments to home health agencies, driven by PDGM budget neutrality adjustments and expanding Medicare Advantage enrollment. HHAs must assess financial impacts, advocate, and optimize operations.
CMS approves New Technology Add-on Payment for Renata Medical's Minima stent, enabling enhanced reimbursement for innovative pediatric congenital heart disease treatment.
CMS 2026 outpatient rule proposes major changes including inpatient-only list elimination and expanded ambulatory surgery center procedures, impacting Medicare payment and compliance.
Explore the 2026 Medicare Part D updates including premium increases, delayed enrollment penalties, and maximum out-of-pocket caps for prescription drugs, with insights into Medicare Advantage plan impacts.
CMS plans a voluntary five-year trial allowing state Medicaid and Medicare Part D plans to cover GLP-1 weight management drugs, including Ozempic and Wegovy, starting in 2026-27 amid pricing and coverage challenges.
Senators introduce bipartisan bill targeting Medicare Advantage overpayments by refining risk adjustment and supporting CMS audits to enhance program integrity and save Medicare billions.
CMS's price-substitution policy has saved $76 million for Medicare by correcting drug pricing identified by the Office of Inspector General, improving cost efficiency while maintaining access.
