The lower reimbursements are a challenge in rural communities with high Medicare Advantage penetration.
The CMS proposes giving Medicare Advantage plans a modest raise and using more patient-care data when setting rates. But the GAO questions the accuracy of patient-care data.
Providers could be making their patients more susceptible to balance or surprise billing because they're not doing enough to ensure their network directories are accurate, according to some experts.
The CMS will launch a new review policy next year to confirm that Medicare Advantage plans' networks are adequate. The agency has found in the past that the doctor information provided by plans is often wrong.
The CMS' proposed changes to the Medicare Advantage risk-adjustment model would increase patient risk scores for mental health, substance abuse and chronic kidney disease conditions.
Starting in 2019, insurers in 15 more states will be able to participate in Medicare Advantage's value-based insurance design program. Plans encourage the use of high-value clinical services among chronically ill patients by lowering or eliminating cost-sharing.
The CMS' proposed changes to the Medicare Advantage program and Medicare prescription drug plans aim to reduce opioid abuse among seniors and dual-eligibles and lessen regulatory burdens for Advantage plans.
The health plan star ratings have come under fire for not including more outcomes measures. Do these measurements reflect the outcomes that matter most to improving care?
The U.S. Justice Department dumped its lawsuit accusing UnitedHealth Group and affiliated health plans of exaggerating how sick its patients were to score millions of dollars in inflated Medicare Advantage payments.
Data released Wednesday reveal that the number of 2018 Medicare Advantage plans that performed well in the CMS' star-ratings program dropped slightly from 2017. At the same time, the amount of insurers that receive certain ratings hasn't changed significantly in recent years.
Cleveland Clinic is working with Anthem Blue Cross and Blue Shield in Ohio to offer a new Medicare Advantage plan, continuing the health system's recent pattern of partnerships with insurance companies.
Cleveland Clinic and Humana are creating two $0 premium Medicare Advantage health plans for seniors in the Cleveland area. The new plans build upon an existing value-based care agreement between the two organizations.