As Medicare Advantage (MA) enrollment surpasses Original Medicare, a new Milliman white paper argues that life sciences companies should no longer view the two programs as interchangeable when developing market access strategies for physician-administered Part B drugs.
Researchers found that each program creates markedly different...Arizona News
A new report says the No Surprises Act of 2020, which established consumer protections and billing rules for providers, isn't resulting in lower premiums as initially expected. But certain providers are netting a windfall through creative workarounds of the rule.
The Congressional Budget Office (CBO) can't say for sure if the No...Arizona News
Criticism continues to mount against the Trump administration's plan to use AI-based prior authorization for Medicare claims. The Wasteful and Inappropriate Service Reduction (WISeR) model, now active in Arizona and five other states, has already generated reports of delayed care for seniors since its January launch. On Tuesday, a House...White Papers, E books, Reports and more
The report finds that more than 14 million seniors rely on Medigap to fill gaps in fee-for-service Medicare, which does not cap out-of-pocket spending and requires cost sharing for hospital and physician services. Enrollment in Medigap has grown steadily in recent years, with 43% of fee-for-service Medicare beneficiaries purchasing...National News
Rates of behavioral health conditions are on the rise among seniors, but older adults are less likely to receive treatment, due in part to restrictions against Medicare-covered patients by outpatient mental health and substance use treatment facilities.
Last week, the Assistant Secretary for Planning and Evaluations (ASPE) Office of...National News
At its December 4 meeting, the Medicare Payment Advisory Committee (MedPAC) reviewed payment data on payment adequacy and potential payment updates and recommendations for its March 2026 report to Congress. This discussion included an update on post-acute care payments and an assessment of hospital performance.
MedPAC commissioners...CMS Rules
Last Friday, the Centers for Medicare and Medicaid Services (CMS) issued a final rule for the 2026 Medicare Physician Fee Schedule. The rule includes a 2.5% pay boost for physicians but creates a 2.5% reduction for 7,700 billing codes for services. It also makes changes to telehealth reimbursement and the Medicare Shared Savings...White Papers, E books, Reports and more
A new study published in the JAMA Health Forum suggests that changes to the risk adjustment formulas used in Medicare's payment system could ensure health plans are fairly compensated for taking on sicker patients from disadvantaged populations.
The JAMA study looked at health and payment data from 4.4 million Medicare beneficiaries...Arizona News
Last Tuesday, the U.S. House of Representatives passed a budget blueprint that includes $880 billion in spending cuts for programs overseen by the House Energy and Commerce Committee. While the expectation is that cuts will impact Medicaid, there is little specificity on what they would mean for the program and the shape of the...Top of The Day
People with mental health symptoms from low to middle-income households use mental healthcare less after aging into Medicare, according to a new study.
The study, conducted by researchers at the University of Southern California's Schaeffer Center sought to address growing concern about access to mental healthcare services under...
As one of the last acts of President Joe Biden's term, the administration listed the prescription pharmaceuticals that would be included in the second round of the program that allows the Centers for Medicare and Medicaid Services (CMS) to negotiate what it pays for certain drugs.
The announcement was made earlier than the...
Republicans in the U.S. House of Representatives are passing around a draft bill that they say would eliminate more than $5 trillion in spending that they could use to pay for incoming President Donald Trump's priorities. The potential spending offsets includes massive changes to Medicare, Medicaid cuts and a "reimagining" of the...Top of The Day
Public support for Medicare is strong, while Medicare Advantage represents half of all Medicare beneficiaries. The differences between these programs require adjustment through policy as the solvency of the Trust Fund comes into question and Medicare spending becomes a target for a new administration that has pledged austerity.
The...National News
A new study looks at the effectiveness of capitated payments for Medicare Advantage plans on reducing incentives for clinicians to provide low-value services.
The study, published in JAMA Network Open, compared data for beneficiaries enrolled in fee-for-service (FFS) Medicare against those enrolled in Medicare Advantage in order to...Arizona News
Insurance company Centene defied the odds for the third quarter and overcame issues with Medicaid reimbursement for higher returns than investors had anticipated.
Centene reported $713 million in profit for Q3 on $42 billion in revenue, up from $469 million and $38 billion last year. Following the Medicaid redetermination period, more...Arizona News
Vice President Kamala Harris and former President Donald Trump delivered their final pitches to the American public this week ahead of election day on November 5. Both candidates refined their positions on healthcare policy and the people they'd entrust with health matters should they win the White House.
Throughout the campaign...National News
Election day is drawing near and the candidates for president are distinguishing themselves with healthcare policy proposals.
Vice President Kamala Harris's campaign released several health-related potential policies over the past several weeks, including a plan to boost long-term care at home. According to Axios, up to a third of...National News
Recent studies and legislative developments indicate significant healthcare changes with potential Medicare coverage for anti-obesity medications (AOMs). The latest analysis, published on August 15, 2024, sheds light on the financial implications and benefits of incorporating a AOMs into Medicare coverage.
Benedic Ippolito, a senior...National Reports & Surveys
A 2023 Affordability Survey reveals significant challenges Americans face with the appeals process for claim denials and billing errors.
Patients and their families are confused about their right to appeal and who to contact, and a high rate of successful appeals suggests potential flaws in the initial determination process. Sara...
At the end of June, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) that includes updates for renal dialysis payments and requirements for the ESRD Quality Incentive Program.
Renal dialysis services will get a 2.2% raise in both...
