Federal payments to Medicare Advantage plans are adjusted for the health status of the plans’ enrollees through a process known as risk adjustment. Generally,…
Adam Colborn, JD, associate vice president for congressional affairs at the Academy of Managed Care Pharmacy, discusses how the Trump administration’s “most favored nation”…
Jeff Ladner, Onspring’s chief product officer, explains what healthcare leaders need to know about Medicare’s six-year WISeR program, which will add new preauthorization requirements,…
Key TakeawaysIndependence Blue Cross’s Medicare Advantage plans received 4 out of 5 stars from CMS for 2026, excelling in customer service and preventive care.The…
Key TakeawaysThe Medicare Part D and Medicaid pilot program will cover obesity drugs at a $50 copay, but implementation details remain unclear.The high wholesale…
Insurers carry out chart reviews to verify alignment between medical records and information submitted by providers. While these reviews can help payers understand a…
Two U.S. Senators have penned a letter to congressional leadership urging them to oppose any measures to bring hospice reimbursement into Medicare Advantage.Sens. Dr.…
A slideshow primer based on updated guidance from CMS.This slideshow lays out changes and continuations of telehealth flexibilities, many of which affect primary-care physicians,…
Providers in the six states of the pilot will need to do advanced administrative processing to ensure claims are approved, says Jeff Ladner, chief…