Reimbursement
Stripped out of the final bill is a provision to prevent the 2.8% Medicare pay cut to physicians.
Higher-than-expected utilization and low reimbursement have challenged the program in 2024.
As soon as the new year begins, Medicare Advantage plans need to implement strategies to improve measures to reach their star ratings goals, says Cindy Henry, director of Population Health Informatics at ZeOmega.
GenAI is expected to streamline documentation for appeals, providing faster reimbursement.
CMS is ordered to recalculate the star ratings without consideration of a "secret shopper" call that framed the dispute.
With three weeks remaining in the legislative calendar, 41 senators have signed a letter to Senate leaders.
The complaint claims the scheme was aimed at suppressing payment rates to doctors for out-of-network services.
Most CFOs are not looking to technology or AI as a solution, says new HFMA report.
Star ratings represent billions of dollars in quality bonus payments. CMS has cost Elevance $375M, the complaint says.
This unsustainable business model and the financial burden are passed on to providers, says Everett Wilson, healthcare regulatory attorney at Polsinelli.