Reimbursement
CMS is proposing to remove measures focused on administrative processes or that do not convey variability in quality among plans.
CMS says limiting healthcare-related taxes and closing tax loopholes will save taxpayers $200B over 10 years.
Providers in the six states of the pilot will need to do advanced administrative processing to ensure claims are approved, says Jeff Ladner, chief product officer at Onspring.
The health system's relationship with Nomi Health makes direct contracts broadly available to self-insured employers in Michigan.
“Level of severity review,” which determines reimbursement, has drawn the ire of the American Hospital Association.
Around 800 laboratory tests will be subject to the payment cuts on Jan. 1, 2026, threatening patient access to diagnostics, letter says.
The 2.5% increase was voted into law in July in the One Big Beautiful Bill Act.
Providers know instantly what’s covered, payers receive more comprehensive claims and patients know their coverage before leaving the doctor's office, Optum says.
The number of Medicare Advantage plans in the state has been cut from eight in 2025 to three for the 2026 plan year.