Medicare & Medicaid

CMS says it considered comments after proposing a 0.09% increase in the Advance Notice.

CMS estimates the revisions will increase federal spending by $18.6 billion over the next decade.

The hospitals want DSH calculations changed back to a pre-2004 standard and payment of additional amounts, plus interest.

The non-binding committee will make recommendations on, among other issues, ways to modernize MA risk adjustment and quality measurement.

The idea is part of the conservative Project 2025 policy.

Providers and payers have two years to comply with the mandate the agency says will save $781 million a year.

CMS is leveraging AI and machine learning to flag possible Medicare and Medicaid fraud. However, COO Kimberly Brandt says experts like clinicians and forensic accountants are needed to verify their findings before action is taken.

CMS envisions frictionless data sharing in which patients can use biometrics to access their records. They can then transfer them using a QR code, explains Amy Gleason, administrator at U.S. DOGE Service and CMS strategic advisor.

Most providers say having the majority of their payers support the Prior Authorization API requirements is extremely important.

A whistleblower, a former Aetna risk-adjustment coding auditor, will receive $2 million.