Medicare & Medicaid
"Plans continue to use AI tools to erroneously deny care and contradict provider assessment findings," lawmakers say.
Final rule disincentives include hospitals not being able to earn three quarters of the annual market basket increase.
Employment-based coverage will be the predominant source of health insurance, and Medicare enrollment will grow significantly.
CMS has paid over $2.5 billion to Part A hospitals and more than $717 million to Part B physicians, suppliers and others.
The decision comes after CMS lost two court cases, but the agency says it reserves the right to appeal.
CMS has been ordered to redetermine the star ratings, which Elevance says should be higher.
The court ruled Humana's compliance costs constitute substantial hardship and denied the DOJ's motion to dismiss for lack of standing.
The ruling could have industry-wide implications for other MA plans seeking to raise their star ratings and bonuses.
MA plans need the correct data because care is not being delivered in front of them, says Anna Basevich, SVP of Enterprise Partnerships and Customer Enablement at Arcadia.
Medicare Advantage may be a victim of its own success as more seniors - and a more sickly population - moves into it.