CMS has proposed a new rule that aims to resolve legal issues over the risk adjustment program’s payment methodology. The rule would ensure that payers will receive appropriate risk...
CMS has announced that monthly Medicare Part D premiums are expected to fall from $33.59 in 2018 to $32.50 in 2019 as new policies to reduce Medicare’s drug costs take effect.
Earlier in 2018,...
Centene and Ascension have partnered to offer a Medicare Advantage plan across multiple geographic markets in 2020.
Centene Chairman and CEO Michael F. Neidorff believes that the partnership...
CAQH CORE is urging healthcare payers, providers, and other stakeholders to promote industry-wide collaboration on how to improve prior authorizations.
Leading provider and payer organizations,...
CMS has proposed a rule that would expand the use of site-neutral payments and improve the drug price negotiation process with manufacturers in order to reduce Medicare’s overall spending.
The...
Highmark BlueCross BlueShield has saved $260 million in avoidable care costs by using value-based reimbursement and provider performance standards to hold healthcare organizations accountable for...
CMS has approved the nation’s first value-based drug purchasing agreement for Medicaid by allowing Oklahoma’s state program to negotiate supplemental prescription drug rebates based on...
The US Senate Budget Committee has penned a letter to HHS Secretary Alex Azar urging the department to address approximately $89 billion in improper payments within Medicare and Medicaid.
The Senators...
Humana and Walgreens have announced the launch of two primary care clinics, designed to meet the needs of Medicare beneficiaries, that will operate within Walgreens locations in the Kansas City...
The Partnership for America’s Health Care Future (PAHCF), a newly formed coalition, consisting of leading healthcare provider societies and payer organizations, has committed to strengthening the...
The new Amazon, Berkshire Hathaway, and JP Morgan & Chase healthcare company will have its inaugural CEO in the next two weeks, Berkshire Hathaway’s CEO Warren Buffett told...
WellCare has entered into a definitive agreement to purchase Meridian Health Plan of Michigan, Meridian Health Plan of Illinois, and MeridianRx in order to increase revenues and expand its footprint in...
A New-York based health system has initiated arbitration with UnitedHealthcare in order to collect $11.5 million in denied reimbursement from claims.
NYC Health + Hospitals, a public healthcare...
Cigna has submitted a filing to the Securities and Exchange Commission (SEC) to complete a $67 billion acquisition of the pharmacy benefit manager (PBM) Express Scripts.
The payer filed the merger...
CMS has released redesigned drug price dashboards to provide information about manufacturer drug costs and advance the agency’s goals of promoting consumer price transparency.
Patients,...
CMS has issued an interim final rule that raises Medicare payments for durable medical equipment (DME) to ensure Medicare beneficiaries have access to critical medical devices.
The rule will raise DME...
A former CMS employee leaked high-level information related to the agency’s rulemaking decisions and changes in provider reimbursement as part of an insider trading scheme, according to a guilty...
CMS has planned to release Medicare Advantage encounter data so that researchers and consumers have the ability to make informed opinions about the cost and healthcare outcomes of the MA program.
The...
HHS Secretary Alex Azar has appointed James Parker as Senior Advisor to the Secretary of the Office of Health Reform to address healthcare challenges related to health insurance costs and health plan...
Humana has expanded a bundled payment model into seven additional states that will cover hip and knee replacements within Medicare Advantage populations.
The payer has teamed up with orthopedic...
