Policy / Regulatory Changes
Signals classified into this topic vertical.
438 signals
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Medicare Program; Public Meeting for New Revisions to the Healthcare Common Procedure Coding System (HCPCS) Level II Coding
This notice announces the second biannual Healthcare Common Procedure Coding System (HCPCS) Level II public meeting of 2026 to discuss the CMS preliminary coding, Medicare benefit category, and Medicare payment determinations, if applicable, for new revisions to the HCPCS Level II code set for non-drug and non-biological items and services, as well as how to register for the meeting.
Policy / Regulatory Changes · 140 signals · last 30 days -
Humana received $130.9M in Medicare Advantage overpayments: OIG
The HHS Office of Inspector General is recommending that Humana refund $130.9 million to the federal government after an audit found that the vast majority of high-risk diagnosis codes submitted by one of the insurer’s largest Medicare Advantage plans were unsupported by medical records. The Sept. 15 audit report is part of a long-running OIG […] The post Humana received $130.9M in Medicare Advantage overpayments: OIG appeared first on Becker's Payer Issues | Payer News .
HumanaHumana · 13 signals · last 30 days -
Delays, tech failures abound in CMS' WISeR AI prior auth pilot, documents show
A trove of CMS documents obtained and shared by a privacy nonprofit outline sweeping issues such as delayed approvals, miscommunication and provider frustration.
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS expanding ACCESS model: 4 things to know
CMS will add four condition tracks to its Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model starting in spring 2027, the agency said in a Sept. 15 news release. Four things to know: 1. The expansion adds heart failure, chronic obstructive pulmonary disease, substance use disorders and tobacco cessation to the model. CMS will […] The post CMS expanding ACCESS model: 4 things to know appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS Adds Medicare Options to Help People Manage Substance Use Disorder, Heart Failure, and Other Common Chronic Conditions
CMS Adds Medicare Options to Help People Manage Substance Use Disorder, Heart Failure, and Other Common Chronic Conditions ACCESS Model Now Available to People with Original Medicare Starting in Spring 2027, the Centers for Medicare & Medicaid Services (CMS) will expand an existing initiative to offer technology-supported care options to Medicare beneficiaries who have heart failure, chronic obstructive pulmonary disease (COPD), substance use disorders, and nicotine dependence. With these add...
Policy / Regulatory Changes · 140 signals · last 30 days -
Federal watchdog calls on MA plans, CMS to address gaps in preventing medical equipment supplier fraud
HHS’ Office of Inspector General released a report in September detailing gaps in efforts to reduce or halt medical equipment supplier fraud in Medicare Advantage. Earlier in the month, CMS announced that it had barred 11 medical suppliers from receiving MA payments following a $3.4 billion fraud probe. Looking at suppliers of durable medical equipment, […] The post Federal watchdog calls on MA plans, CMS to address gaps in preventing medical equipment supplier fraud appeared first on Becker'...
Policy / Regulatory Changes · 140 signals · last 30 days -
OIG urges crackdown on equipment suppliers in Medicare Advantage
The agency says the CMS and MA organizations aren’t doing enough to screen durable medical equipment providers, especially out-of-network companies that aren’t enrolled in Medicare.
Policy / Regulatory Changes · 140 signals · last 30 days -
PUBLIC COMMENT — Medicare and Medicaid Programs: Calendar Year 2027 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program, CMS-2026-2377-0002
The post PUBLIC COMMENT — Medicare and Medicaid Programs: Calendar Year 2027 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program, CMS-2026-2377-0002 appeared first on Paragon Health Institute .
Policy / Regulatory Changes · 140 signals · last 30 days -
HCSC completes rebrand of Cigna’s former Medicare business
Health Care Service Corp. has completed the rebranding of its Medicare supplement and supplemental health and life products under the HealthSpring name. The move finishes a transition that began last year, when HCSC shifted the Medicare Advantage and Part D business it acquired from Cigna for $3.3 billion to the HealthSpring brand. HealthSpring has more […] The post HCSC completes rebrand of Cigna’s former Medicare business appeared first on Becker's Payer Issues | Payer News .
CignaCigna · 15 signals · last 30 days -
CMS, SBA, and Georgia Recognize Innovative CHOICE Arrangements as Major Win for Small Businesses
CMS, SBA, and Georgia Recognize Innovative CHOICE Arrangements as Major Win for Small Businesses Trump Administration Initiative Expands Resources for Health Insurance Affordability, Choice, and Coverage Options for Small Businesses and Workers
Policy / Regulatory Changes · 140 signals · last 30 days -
AHA comments on physician fee schedule proposed rule for CY 2027
The AHA provided comments to the Centers for Medicare & Medicaid Services Sept. 14 on the calendar year 2027 physician fee schedule proposed rule. The AHA expressed support for proposals regarding the Medicare Shared Savings Program that would expand participation in accountable care, such as establishing guardrails for the Accountable Care Prospective Trend, increasing the BASIC track Level E sharing rate and prior savings adjustment scaling factor, and enhancing beneficiary engagement throu...
Policy / Regulatory Changes · 140 signals · last 30 days -
Medicare’s GLP-1 program is ‘far exceeding’ expectations, but a plateau could be coming
Pharmacies have been seeing compelling interest in Medicare’s GLP-1 Bridge program since its July launch, NPR first reported. The demonstration, designed to give eligible Medicare Part D beneficiaries access to certain GLP-1s at a fixed monthly cost, will run through 2027. Manufacturers are supplying GLP-1s at a monthly net price of $245, and beneficiaries cover […] The post Medicare’s GLP-1 program is ‘far exceeding’ expectations, but a plateau could be coming appeared first on Becker's Paye...
Policy / Regulatory Changes · 140 signals · last 30 days -
United States ex rel. Poehling v. UnitedHealth Group Inc. et al.
Medicare Advantage risk adjustment coding litigation. The post United States ex rel. Poehling v. UnitedHealth Group Inc. et al. appeared first on Health Care Litigation Tracker .
UnitedHealthUnitedHealthcare · 46 signals · last 30 days -
Feds propose some Medicare reimbursement cuts. Oklahoma doctors say it will endanger patients.
The Centers for Medicare and Medicaid Services (CMS) is proposing a significant rule change that would mean physicians receive half as much in reimbursement from Medicare for services provided on the same day as an office visit. The American Medical Association and more than 150 healthcare organizations, including the Oklahoma State Medical Association, are calling […]
Policy / Regulatory Changes · 140 signals · last 30 days -
CCF Comments on CMS Proposed Provider Tax Rule
The Georgetown University Center for Children and Families submitted the following comments to the Center for Medicare and Medicaid (CMS) regarding CMS’s proposed rule to amend the Indirect Hold Harmless Threshold of Health Care-Related Taxes. Read the Comments.
Policy / Regulatory Changes · 140 signals · last 30 days -
More than half of hospitals still not fully compliant with price transparency rules: report
A record number of hospitals are fully sharing data on the cost of their services, thanks to the CMS stepping up enforcement. But there’s still a ways to go, according to PatientRightsAdvocate.org.
Policy / Regulatory Changes · 140 signals · last 30 days -
Agency Information Collection Activities: Submission for OMB Review; Comment Request
The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (PRA), federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, and to allow a second opportunity for public comment on the notice....
Policy / Regulatory Changes · 140 signals · last 30 days -
Interra Health now supports CMS’ GLP-1 Bridge Program
Interra Health’s platform alerts providers when patients may be eligible to enroll in the program, executives say.
Policy / Regulatory Changes · 140 signals · last 30 days -
Half of Medicare Advantage stars thresholds harder to reach in 2027
The CMS released draft star ratings, including the thresholds for reaching those ratings, to plans earlier this week. The grading sheet got stricter, which doesn’t bode well for insurers, one MA expert said.
Policy / Regulatory Changes · 140 signals · last 30 days -
Privacy Act of 1974; System of Records
In accordance with the Privacy Act of 1974, as amended, the Department of Health and Human Services (HHS) is modifying an existing system of records maintained by the Centers for Medicare & Medicaid Services (CMS), titled "Hospice Item Set (HIS) System," System No. 09-70-0548. The amended System of Records Notice (SORN) reflects changes to now include real time data collection at the time of patient assessments to improve the understanding of patient care needs and care coordination. CMS is a...
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS puts more pressure on DME suppliers as part of anti-fraud push
The Trump administration is cracking down further on durable medical equipment suppliers as part of its broader push to root out fraud.
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS Cracks Down on Massive $3.4 Billion Medical Equipment Supplier Fraud Scheme
CMS Cracks Down on Massive $3.4 Billion Medical Equipment Supplier Fraud Scheme Companies Billed Medicare for Deceased Beneficiaries
Policy / Regulatory Changes · 140 signals · last 30 days -
Healthcare spending drove 91% of commercial premium growth over 13 years: Study
Growth in healthcare spending, not insurer profit margins, drove the vast majority of commercial premium increases over more than a decade, according to a study published Sept. 4 in JAMA Health Forum. Researchers at Yale University and the University of Wisconsin-Madison analyzed CMS data from 2011 to 2024 covering the large group, small group and […] The post Healthcare spending drove 91% of commercial premium growth over 13 years: Study appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS bars 11 suppliers from MA payments after $3.4B fraud probe
CMS has been cracking down on possible fraud with medical equipment suppliers for months, sharing two major updates in recent weeks. CMS announced that it is barring 11 medical supply companies focused on durable medical equipment, prosthetics, orthotics and supplies from earning future Medicare Advantage Part C and Part D payments. In 2025 and 2026, […] The post CMS bars 11 suppliers from MA payments after $3.4B fraud probe appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
Why “Good” Is Expensive: The Cost of Falling Below 4 Stars in Medicare Advantage
A 3.5-Star Medicare Advantage rating can be far more expensive than it looks. As an example, in 2026, approximately 40% of Medicare Advantage prescription drug contracts earned four Stars or higher, meaning roughly six in 10 fell below that threshold. These ratings will affect 2027 Medicare Advantage Quality Bonus Payments, making today’s quality performance a […] The post Why “Good” Is Expensive: The Cost of Falling Below 4 Stars in Medicare Advantage appeared first on Becker's Payer Issues...
Policy / Regulatory Changes · 140 signals · last 30 days