Compliance, regulatory fairness, and $115m in bonus payments are at the heart of why insurer Elevance Health says it is taking CMS to court.
Medicare Advantage
Of the 15 bills considered in the legislative markup session, several related to price transparency, access to care, and prior authorization reform.
A potentially $50 billion proposal to cap traditional Medicare out-of-pocket costs would trigger serious compliance and operational changes across CMS, Medigap, and Medicare Advantage.
Two reports examined prior authorization practices at the three largest Medicare Advantage Organizations across acute care, rehabilitation, and nursing facilities.
Payor and provider groups are saying the rate increases may not be enough to stave off cuts to coverage.
Insurer agreed to resolve US allegations that inaccurate diagnosis data for plan members inflated risk-adjusted payments from federal Medicare program.
CMS alleges that the health insurance giant repeatedly provided risk adjustment data via unapproved external flash drives.
The agency is also proposing a shift in the risk-adjustment model traditionally used in the MA program.