As CMS ramps up its RADV initiatives in the months ahead, plans should ensure their risk adjustment programs meet the highest standards of accuracy and compliance. Prospective and retrospective analytics enhanced by AI can help plans work with providers to optimize documentation at the point of care and identify coding errors during audit preparation.
The Trump administration's Make America Healthy Again nutrition policies and Medicare Advantage plan ethics were prominent themes on the latest episode of the Debunked Podcast with MedCity News Editor-in-Chief Arundhati Parmar and guest co-host Paul Markovich, CEO of Blue Shield of California parent company Ascendiun.
In today’s healthcare landscape, your choice of medical billing partner directly impacts your bottom line. What are the best medical billing outsourcing companies, and which one is right for you?
Two U.S. representatives have introduced the Prompt and Fair Pay Act, a bipartisan bill that would require Medicare Advantage plans to reimburse providers at least the same rates as traditional Medicare, as well as pay claims more promptly. Providers and industry groups have welcomed the proposal, citing mounting financial strain and growing concerns over care delays and denials.
A recent KFF report showed that in 2024, 79% of counties in the U.S. were highly concentrated for Medicare Advantage, and 18% were very highly concentrated.
To remain resilient amid the volatility, skilled nursing facilities need to stay on top of what’s impacting operations and consider strategic opportunities. Here are important trends to watch.
The 2026 Medicare Advantage Rate Announcement is more than just funds allocation — it signals a policy shift. It’s the next phase of value-based care and encourages every stakeholder in the MA ecosystem to rise to the occasion.
Neurologists and health care practitioners must evolve with the world. Telemedicine carts assist in this evolution by serving as an intermediary between patients and doctors.
DUOS recently won the health tech consumer/employer track of MedCity News’ INVEST Pitch Perfect contest. The company supports older adults and their caregivers by addressing health-related social needs and connecting patients to care.
Earlier this month Sachin Jain, CEO of SCAN Health Plan, a nonprofit Medicare Advantage company, provided some refreshing straight talk on what is wrong with MA while stressing that it is far better than traditional Medicare for seniors.
SCAN Group is partnering with Sutter Health to develop new Medicare Advantage products and eventually launch a joint venture Medicare Advantage plan.
The goal of the Two-Midnight Rule, originally introduced under traditional Medicare Part A, was to reduce hospital admissions and to ensure the appropriate use of inpatient versus outpatient observation status. Here are some challenges and best practices.
Explore top-tier aesthetic certification programs that blend theory with hands-on training — perfect for health care pros ready to elevate their practice
CMS recently announced that payments to Medicare Advantage plans will increase by 5.06%, drawing support from payer advocates.
The distinction between value-based care and value-based payment isn't merely semantic — it represents a crucial fork in the road for healthcare delivery. As AI and other technologies become more prevalent in healthcare, we must ensure they're deployed in service of improving patient care rather than merely optimizing revenue.
Medicare Advantage plans can more effectively position themselves for success under an evolving measurement system. Here are three strategic actions health plan leaders should prioritize to enhance 2026 bids to secure stronger Star Rating performance.
Organizations with underperforming Medicare Advantage plans can, and should, start taking steps now to establish a strong foundation that can sustain long-term success
The impact of private equity investments in healthcare under the new administration is multifaceted. While deregulation and business-friendly policies could stimulate investment and drive innovation, there are significant concerns about the potential negative effects on healthcare quality and access.