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The approach will be used for medical services that are commonly subject to prior authorization, such as orthopedic surgeries and imaging services.
CMS says it considered comments after proposing a 0.09% increase in the Advance Notice.
Close to 45% of payments flow through value-based models, with 28.7% in downside risk, according to AHIP survey.
Proposed rule increases requirements for price comparison tools by aligning them with consumer protections established under the No Surprises Act.
America’s Health Insurance Plans also responds to GAO report on fraud risk in the program.
Health plans identify 39% of all disputes as ineligible, including 45% of non-emergency service disputes.
That includes a $7.7 billion increase in demand for uncompensated care, numbers showed.
Health plans will continue to cover recommended immunizations with no cost-sharing through the end of 2026, AHIP says.
However, extending the credits would also increase the federal deficit, CBO says.
Baptist Health Chief Revenue Officer says the health system will often eat the cost of a service rather than delay care.
