Healthcare Dive

FEBRUARY 10, 2023

The CMS has laid out how it plans to implement a key provision of the Inflation Reduction Act requiring drugmakers to pay rebates on price hikes in Medicare that are greater than inflation.

Medicare 269

Medicare Medicare 269

Healthcare Dive

AUGUST 2, 2024

Hospitals still weren’t happy with the final rule despite the bump from the CMS’ proposed rates, citing cuts to long-term and disproportionate share facilities.

Medicare 309

Medicare Medicare Hospitals 309

Healthcare Dive

OCTOBER 11, 2024

About 40% of MA plans with prescription drug coverage will earn four or more stars, a dip from 42% this year, according to data released by the CMS.

Medicare 294

Medicare Medicare 294

Healthcare IT Today

JANUARY 8, 2025

As we wrap up another year and get ready for 2025 to begin, it is once again time for everyone’s favorite annual tradition of Health IT Predictions! Check out the community’s predictions down below and be sure to follow along as we share more 2025 Health IT Predictions !

Hospitals 90

Hospitals Payment Systems Licensing Medicaid 90

MRO Compliance

JANUARY 16, 2025

2025 has arrived and with it brings new challenges and potential opportunities to the healthcare landscape. Below we will discuss some strategies for payers to overcome these challenges and rest assured that they are doing all they can to innovate and change in 2025.

Overpayments 130

Overpayments Overpayment Regulatory Compliance Patient Satisfaction 130

Healthcare IT Today

DECEMBER 30, 2024

As we wrap up another year and get ready for 2025 to begin, it is once again time for everyone’s favorite annual tradition of Health IT Predictions! Check out the community’s predictions down below and be sure to follow along as we share more 2025 Health IT Predictions !

US Department of Health and Human Services 91

US Department of Health and Human Services Nurses Medicare Medicare 91

Healthcare IT Today

DECEMBER 24, 2024

As we wrap up another year and get ready for 2025 to begin, it is once again time for everyone’s favorite annual tradition of Health IT Predictions! Check out the community’s predictions down below and be sure to follow along as we share more 2025 Health IT Predictions ! From 2020 to 2050, the percentage of U.S.

Telemedicine 92

Telemedicine Medicaid Medicaid Doctors 92

Healthcare Dive

JULY 31, 2024

The insurer shrank its plan footprint for 2025 in a bid to improve margins. Now, Humana is giving market watchers loose guidance into how that reduction could affect its enrollment along with second quarter results.

Medicare 337

Medicare Medicare 337

Healthcare Dive

JUNE 6, 2024

Hundreds of thousands of seniors could switch plans during next year’s open enrollment, depending on how drastically the MA market giants slash benefits in an attempt to improve profits.

Medicare 334

Medicare Medicare 334

Healthcare Dive

NOVEMBER 25, 2024

A Texas federal judge has sided with UnitedHealthcare in determining regulators messed up calculating its Medicare Advantage quality scores for next year. The decision could have big implications for similar pending cases.

Medicare 306

Medicare Medicare 306

Healthcare Dive

OCTOBER 3, 2024

Only 25% of Humana members will be in plans with four stars or above next year, down from 94% this year, the insurer disclosed Wednesday. The downgrade could wipe out Humana’s profits in 2026.

Medicare 294

Medicare Medicare 294

Hall Render

FEBRUARY 17, 2025

According to a statement released on the Center for Medicare and Medicaid Services (CMS) website, effective February 14, 2025, implementation of the Hospice Special Focus Program for calendar year 2025 has ceased so that CMS may further evaluate the program. However, CMS noted that for one data source, only 49.3%

Medicare 89

Medicare Medicare Nursing Homes Medicaid 89

Healthcare Dive

JULY 11, 2024

Regulators said Medicare’s budget neutrality requirement is to blame for the reduction, which was quickly decried by provider groups. However, it’s likely Congress will step in to mitigate the drop.

Medicare 305

Medicare Medicare 305

Medisys Compliance

FEBRUARY 19, 2025

Billing Update: Medicare Radiology Reimbursement Cuts 2025 Effective January 2025, radiology practices nationwide are facing reduced Medicare reimbursements due to finalized changes in the Physician Fee Schedule. Now, in February 2025, these proposed rules are our current reality.

Medicare 59

Medicare Medicare Medical Billing Outsourcing Medical Billing 59

Healthcare Dive

FEBRUARY 1, 2024

The CMS proposed a 0.2% dip in MA rates. However, analysts said regulators will likely improve the payment rate in the final notice.

Medicare 276

Medicare Medicare 276

Healthcare IT Today

JANUARY 14, 2025

As we wrap up another year and get ready for 2025 to begin, it is once again time for everyone’s favorite annual tradition of Health IT Predictions! Check out the community’s predictions down below and be sure to follow along as we share more 2025 Health IT Predictions !

ACA 83

ACA Medicaid Medicaid Fraud 83

Healthcare Dive

OCTOBER 23, 2024

Centene is emulating other insurers unhappy with how regulators handled quality ratings for 2025. The flurry of complaints is “symptomatic of what appear to be systemic issues” with CMS calculations, Centene said.

Medicare 269

Medicare Medicare 269

Medisys Compliance

JANUARY 23, 2025

As we step into 2025, mental health providers must stay informed about evolving telehealth billing regulations to ensure compliance and optimize reimbursement. Will Medicare Stop Paying for Telehealth in 2025? What Is the CPT Code for Telehealth in 2025? CPT codes are essential for billing telehealth services accurately.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medicare Medicare Medical Billing 59

Fierce Healthcare

OCTOBER 10, 2024

Just 40% of Medicare Advantage prescription drug plans offered in 2025 achieved a score of four stars or higher, the Centers for Medicare & Medicaid Services (CMS) revealed Oct. It's harder than ever for Medicare Advantage plans to score well on star ratings. Here's how they performed for 2025.

Medicare 126

Medicare Medicare Medicaid Medicaid 126

Healthcare Dive

NOVEMBER 4, 2024

The payer joins several other insurers suing federal regulators over the 2025 quality ratings, which Elevance argues will cost it at least $375 million in bonus payments and rebates.

Medicare 253

Medicare Medicare 253

HealthIT Answers

JANUARY 22, 2025

CMS has made substantial progress on its goal for all people with Traditional Medicare to be in a care relationship with accountability for quality and total cost of care by 2030. As of January 2025, 53.4% of people with Traditional (fee-for-service) Medicare are in an accountable care relationship with a provider.

Medicare 69

Medicare Medicare 69

Fierce Healthcare

NOVEMBER 2, 2024

The Centers for Medicare and Medicaid Services (CMS) is moving forward with a 2.9% cut to physician payments in 2025 despite protest from major industry groups. | The Centers for Medicare and Medicaid Services (CMS) is moving forward with a 2.9% cut to physician payments in 2025 despite protest from major industry groups.

Medicare 132

Medicare Medicare Doctors Medicaid 132

Fierce Healthcare

OCTOBER 11, 2024

Analyses of 2025 Medicare Advantage star ratings continue to pour in and not all of it bodes well for the conventional juggernauts. UnitedHealth and Humana saw star ratings decrease, whereas insurtechs celebrated their scores. We break down how all major insurers—and their investors—are reacting.

Medicare 126

Medicare Medicare 126

Fierce Healthcare

JANUARY 31, 2024

Medicare Advantage (MA) payments are set to decrease yet again in 2025 as the feds phase in significant changes to risk adjustment. Medicare Advantage payments are set to decrease yet again in 2025 as the feds phase in significant changes to risk adjustment.

Medicare 124

Medicare Medicare 124

HealthIT Answers

MARCH 11, 2025

This is notification that eligible hospitals and critical access hospitals participating in the Centers for Medicare & Medicaid Services Promoting Interoperability Program that there is an upcoming data submission deadline on March 14, 2025, at 11:59 p.m. Pacific Time.

Medicaid 59

Medicaid Medicaid Medicare Medicare 59

HealthIT Answers

APRIL 3, 2025

By Lauren Barca, MHA, RN - The headlines for 2025 Medicare, Medicaid, and dual-eligible programs are rife with concerns about proposed changes. While those worries were certainly a topic of discussion at AHIPs recent Medicare, Medicaid, Duals, and Commercial Markets Forum in Baltimore, Maryland, they werent the only story.

Medicaid 59

Medicaid Medicaid Medicare Medicare 59

Fierce Healthcare

DECEMBER 16, 2024

Medicare Advantage has steadily grown over the past decade, and now encompasses more than half of all seniors eligible for Medicare. Medicare Advantage has steadily grown over the past decade, and now encompasses more than half of all seniors eligible for Medicare.

Medicare 126

Medicare Medicare 126

Medisys Compliance

FEBRUARY 10, 2025

As the healthcare landscape continues to evolve, 2025 brings a wave of changes in the coding and billing arena for mental health services. In this detailed guide, we explore the updated CPT codes for mental health in 2025, discuss changes in psychotherapy and psychiatric evaluation codes, and outline strategies to avoid claim denials.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medical Billing Compliance Medical Billing Services 59

Healthcare IT Today

MARCH 5, 2025

Here’s a quick look at some of the health IT jobs we found: Healthcare Cyber Security Principal – RSM US LLP Associate Chief Medical Informatics Officer-Inpatient – Baptist Memorial Health Care Director of Clinic Operations – McLaren Health Care IT Manager, Technical Services (IAM) – HMSA Health Information Analyst (Full (..)

Due Diligence 112

Due Diligence Medicare Medicare Hospitals 112

Healthcare IT Today

APRIL 5, 2025

Read more… Ensuring Accuracy When Translating Medicare Advantage Materials. Read more… This Weeks Health IT Jobs for April 2, 2025: Multiple roles in information management, compliance, and patient access. This one’s pretty self-explanatory. The most interesting conversation to me?

Records Management 60

Records Management Telemedicine Medicare Medicare 60

Healthcare Dive

MAY 17, 2022

The payer plans to open about 100 new value-based primary care clinics for Medicare patients between 2023 and 2025 through the latest deal.

Medicare 258

Medicare Medicare 258

Medisys Compliance

FEBRUARY 18, 2025

Running a behavioral health practice is demanding, and understanding 2025 behavioral health billing changes might feel like another burden. As we look towards 2025, there are some potential shifts on the horizon that could affect how you bill, get paid, and even how you structure your day-to-day work.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Licensing Medical Billing Patient Satisfaction 59

Fierce Healthcare

SEPTEMBER 27, 2024

Medicare's open enrollment window opens in a few weeks, and the Centers for Medicare & Medicaid Services is offering a broad look at the landscape around Medicare Advantage and Part D before si | Medicare's open enrollment window opens in a few weeks, and the Centers for Medicare & Medicaid Services is offering a broad look at the (..)

Medicare 121

Medicare Medicare Medicaid Medicaid 121

Healthcare IT News - Telehealth

APRIL 22, 2024

Medicare was the first to cover RPM. If the AMA approves the changes under consideration, and Medicare follows suit, which it usually does, then providers who make modifications and expand their RPM programs to fit the new codes will gain the most benefits for their patients and their clinics. However, the federal agency often does so.

Medicare 194

Medicare Medicare Medicaid Medicaid 194

Fierce Healthcare

APRIL 1, 2024

Insurers will feel resentful Monday as the feds opted to not reverse its decision to decrease Medicare Advantage benchmark payments by 0.16%, the Centers for Medicare and Medicaid announced. | CMS is not deviating from its January proposal to modestly rein in Medicare Advantage.

Medicare 143

Medicare Medicare Medicaid Medicaid 143

Fierce Healthcare

JUNE 3, 2024

Blue Cross and Blue Shield of Kansas City is leaving the Medicare Advantage (MA) market at the end of 2024, the insurer announced recently. Blue Cross and Blue Shield of Kansas City is opting out of the Medicare Advantage market.

Medicare 124

Medicare Medicare 124

Bill of Health

OCTOBER 17, 2024

This aligns with recent guidance from the Centers for Medicare and Medicaid Services that Medicare Advantage plans may not make a determination of medical necessity solely based on algorithms using broad data sets. 2025) research interests are focused on the intersection of health and the law. Rebekah Ninan’s (J.D.

Medicare 150

Medicare Medicare Health Insurance Licensing 150