Medicare Advantage Chart Reviews Drive Higher Diagnoses and Federal Payments
KFF research reveals widespread use of chart reviews in Medicare Advantage, increasing diagnoses and boosting CMS payments with AI-driven risk adjustment implications.
Medicare Advantage Shifts Focus From Growth to Profitability Amid Regulatory Changes
Medicare Advantage market pivots from growth-at-any-cost to profitability-first amid CMS regulatory tightening and rising medical costs. Key strategic shifts include operational efficiency, agility in member services, and investment in clinical programs to improve outcomes and reduce total care costs.
Algorithms Enhance Fairness in Medicare Advantage Risk Adjustment Payments
New algorithmic approaches improve fairness in Medicare Advantage payment models, promoting equitable spending for minority beneficiaries without reducing predictive accuracy.
Senators Propose Bill to Tighten Medicare Advantage Risk Adjustment, Curb Overpayments
Senators introduce bipartisan bill targeting Medicare Advantage overpayments by refining risk adjustment and supporting CMS audits to enhance program integrity and save Medicare billions.
AI and Legislative Actions Aim to Address Medicare Advantage Coding Disputes
Explore how AI innovations and the No UPCODE Act seek to resolve Medicare Advantage coding controversies, improving risk adjustment and compliance.
CMS Expands Medicare Advantage Audits Impacting Major Health Insurers
CMS expands Medicare Advantage audits from 2018-2024, intensifying compliance demands and financial scrutiny for major health insurers like UnitedHealth, CVS, and Humana.