The proposal would eliminate the financial motivation insurers have to mine their members’ charts for additional diagnoses.

Policymakers are exploring reforms to address shortcomings of risk adjustment that inflate Medicare Advantage payments and ...

Earlier this week, the Centers for Medicare & Medicaid Services (CMS) released the Contract Year (CY) 2027 Medicare Advantage (MA) and Part D ...

Among other provisions, the Rate Announcement includes the following: Payment Changes/Growth Rates: The effective growth rate for 2024 MA non-End-Stage Renal Disease (ESRD) rates is 2.28%, a slight ...

Persistent favorable selection to Medicare Advantage (MA) generates large annual overpayments because beneficiaries who switch to MA systematically use fewer medical services than those who remain in ...

Medicare Advantage (MA) is privately administered health care insurance for seniors and persons with disabilities. The program has grown rapidly and now covers more than half of Medicare-eligible ...

If you read the memo and muttered, "uh-oh" under your breath, you might be thinking that your plan/organization owes CMS some money, and soon. If you haven't read this memo, "uh-oh" would be an ...