Federal Court Boosts Alignment Healthcare's Medicare Advantage Star Rating
Federal court ruling raises Alignment Healthcare's Arizona Medicare Advantage star rating to 4 stars, impacting quality ratings and bonus payments in 2025.
Civitas Survey Highlights Medicare Quality Improvement Organizations’ Impact and Future Needs
Survey by Civitas Networks for Health shows Medicare Quality Improvement Organizations generated $4.7B savings and highlights recommendations for program enhancements focusing on data interoperability, onsite training, and workforce retention.
CMS Pilots Medicare Pre-Authorization Requirements in Six States
CMS launches a six-year pilot requiring pre-authorizations for 17 medical services in traditional Medicare across six states, aiming to control costs and reduce service overuse.
Electronic Caregiver Launches Addison Care: AI-Driven 3D Virtual Caregiver for Medicare under CMS Codes
Electronic Caregiver introduces Addison Care, the first 3D AI-powered virtual caregiver integrated with athenaOne EHR, delivering enhanced Remote Patient Monitoring and Chronic Care Management services for Medicare patients under CMS reimbursement.
CMS Alerts Medicare Providers to Rise in Fraudulent Fax-Based Medical Record Phishing
CMS warns Medicare providers of rising phishing scams via fraudulent fax requests for medical records falsely linked to audits. Providers urged to verify requests to protect patient data.
CMS Finalizes Rule Tightening ACA Enrollment, Aiming to Reduce Premiums
CMS finalizes 2025 Marketplace Integrity and Affordability Final Rule to tighten ACA Exchange enrollments, aiming to lower premiums but reducing coverage for some. Key provisions include subsidy restrictions and exclusions for DACA recipients.
CMS Finalizes Rule Targeting ACA Enrollment Fraud, Aims to Lower Premiums
CMS finalizes new rule to reduce ACA improper enrollments, aiming to lower premiums and save taxpayers billions by 2026, while raising concerns over coverage losses.
Medicare Data Shows Rising CAS Use but No Shift Away from CEA Post-CMS Coverage Expansion
Analysis of Medicare data reveals increased carotid artery stenting use but stable carotid endarterectomy rates after CMS expanded CAS coverage in 2023, highlighting evolving vascular surgeon roles and compliance challenges.
CMS Expands Medicare Advantage Audits to Address $43B Overpayments
CMS is intensifying Medicare Advantage audits to recover $43 billion in overpayments, impacting provider contracts and regulatory compliance across the MA ecosystem.
2025 Medicare Advantage Star Ratings Drop Spurs Health IT Innovation Across Payers
The 2025 decline in Medicare Advantage Star Ratings intensifies regulatory scrutiny. Black Book Research reveals health IT strategies top plans use to boost quality, member experience, and compliance across all payers.