How Medicare Pays Medicare Advantage Plans: Issues and Policy Options
This brief explains how Medicare Advantage payments are determined and provides an overview of policy…
How Medicare Pays Medicare Advantage Plans: Issues and Policy Options
This brief explains how Medicare Advantage payments are determined and provides an overview of policy options to change the Medicare Advantage payment system.
Medicare Advantage Glossary
This glossary serves as a guide to the sometimes arcane terms that inhabit the world of Medicare Advantage, the private plan alternative to traditional Medicare.
Chart Reviews Increase Payments to Medicare Advantage Insurers for 1 in 6 Enrollees
Using Medicare Advantage encounter data, this analysis finds that 62% of Medicare Advantage enrollees have at least one chart review record and that diagnoses added from chart reviews increase payments from CMS to insurers for 17% of enrollees. The use of chart reviews varies across the largest Medicare Advantage insurers.
The Case for a Universal Medical Coder in Achieving True Interoperability
A universal medical coder, applied consistently across care settings, offers a practical solution to the enduring challenge of data integrity. The post The Case for a Universal Medical Coder in Achieving True Interoperability appeared first on MedCity News.
A Perfect Storm is Brewing Within the U.S. Healthcare Workforce: Public Policy, Data, and AI Will Help Us Weather It
Weathering the storm will require a bold, multi-pronged approach encompassing legislative action and a data-informed approach that leverages AI technology to plan, recruit, and realign more efficient care models. The post A Perfect Storm is Brewing Within the U.S. Healthcare Workforce: Public Policy, Data, and AI Will Help Us Weather It appeared first on MedCity…
Cáncer de mama y anticonceptivos: un nuevo estudio revela cómo se puede distorsionar la ciencia
Mientras la desinformación sobre la salud de las mujeres se propaga más rápido que nunca, médicos dicen que una nueva investigación sobre los riesgos de los anticonceptivos hormonales pone en evidencia los desafíos de comunicar con matices en la era de las redes sociales. El extenso estudio, realizado en Suecia, siguió a más de 2…
Complaints About Gaps in Medicare Advantage Networks Are Common. Federal Enforcement Is Rare.
Along with the occasional aches and pains, growing older can bring surprise setbacks and serious diseases. Longtime relationships with doctors people trust often make even bad news more tolerable. Losing that support — especially during a health crisis — can be terrifying. That’s why little-known federal requirements are supposed to protect people with privately run…
Waning Immunity and Falling Vaccination Rates Fuel Pertussis Outbreaks
Rates of pertussis, also known as whooping cough, are surging in Texas, Florida, California, Oregon, and other states and localities across the country. The outbreaks are fueled by falling vaccination rates, fading immunity, and delays in public health tracking systems, according to interviews with state and federal health officials. Babies too young to be fully…
How will new H-1B fees impact rural hospitals?
On September 19, 2025, an executive order increased the fee for new H-1B petitions from approximately $3500 to $100 000 per applicant. How is this policy likely to impact the healthcare workforce in the U.S.? A paper by Liu et al. (2025) uses Department of Labor data on certified Labor Condition Applications (LCAs) supporting H-1B visas…
Bayer Lung Cancer Drug Lands Speedy FDA Nod to Stay Competitive With a Boehringer Ingelheim Med
The accelerated FDA approval of Bayer’s Hyrnuo covers treatment of advanced cases of non-small cell lung cancer with HER2 mutations. It will compete against an HER2-targeting Boehringer Ingelheim pill approved in August. The post Bayer Lung Cancer Drug Lands Speedy FDA Nod to Stay Competitive With a Boehringer Ingelheim Med appeared first on MedCity News.
