Medicare Advantage incurs a $5.7 billion underwriting loss in 2024 due to increased utilization, medical inflation, and regulatory changes, impacting insurer profitability and market dynamics.
Medicare to pilot AI-driven preauthorization program in six states as federal budget cuts threaten program funding and patient access.
OIG finds nursing homes underreporting major injury falls affecting accuracy of CMS Care Compare data; CMS to enhance compliance and reporting measures.
CMS invites states to apply for the $50B Rural Health Transformation program aimed at improving rural health outcomes, with a Nov. 5 deadline and specific funding rules.
Medicare's 2025 payment updates introduce advanced primary care and behavioral health codes poised to reshape reimbursement landscapes, addressing primary care financial challenges and influencing specialist payment cuts.
CMS's 2026 Medicare payment proposals aim to rebalance reimbursements in favor of primary care and outpatient clinics, reduce hospital-owned clinic premiums, and introduce site-neutral payments to improve Medicare value and primary care sustainability.
The August 2025 OIG report analyzes Medicare billing for remote patient monitoring services, highlighting fraud risks and compliance recommendations amid rising RPM usage.
CMS GUIDE program integrates palliative care to improve support and care coordination for dementia patients and caregivers under Medicare Part B, addressing challenges in symptom management and caregiver respite.
The CMS 2026 proposed physician fee schedule includes updates to Medicare telehealth reimbursement, frequency limits, and supervision rules, aiming to codify pandemic-era telehealth flexibilities.
A federal court blocks key provisions of the CMS Marketplace Integrity and Affordability rule affecting ACA exchanges, prompting an appeal from the Trump administration. Changes impact health plan design, enrollment rules, and taxpayer costs.
