Tag: Medicare Beneficiaries

How a Medicare Out-of-Pocket Cap Could Reshape Healthcare

For millions of Americans relying on Medicare, the specter of high out-of-pocket healthcare costs looms large. Unexpected illnesses, chronic conditions, and even routine medical needs can quickly erode savings and create significant financial strain. The idea of a Medicare out-of-pocket spending cap has long been a topic of discussion, promising a shield against catastrophic expenses. […]
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Medicare Advantage and Part D rule

Medicare Rights Center Comments on 2026 Medicare Advantage & Part D Rule

The Medicare Rights Center has submitted comments on the proposed Medicare Advantage and Part D rule for 2026 from the Centers for Medicare & Medicaid Services (CMS). This annual rule introduces critical provisions aimed at strengthening prior authorization standards, enhancing transparency, and improving access to accurate plan information for beneficiaries. We strongly support these reforms […]
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Specialty care improves outcomes and reduces costs for CMS

Specialty care improves outcomes and reduces costs for CMS

Streamlining Specialty Care: CMS’s Innovation Center prioritizes strategies that improve personalized healthcare information, implement financial services, and support segment-based classifications. A value-based approach to care must address underlying issues and individualized care to reduce patient outcomes. CMS’s innovation strategy describes ongoing efforts to integrate personalized care into the healthcare system. Previous studies have shown that […]
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Medicare Conversion Factor Increases, But Payments Remain Lower

Medicare Conversion Factor Increases, But Payments Remain Lower

Medicare Conversion factor are up but payouts are still down compared to last year. Healthcare professionals will see a slight upward adjustment to their Medicare payments starting March 9 after President Biden signs the Consolidated Appropriations Act (CAA), 2024.  Really fortunately, although the 2024 CAA increases the conversion factor (CF) finalized for calendar year (CY) […]
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CMS Enhanced Patient Appeal Procedures

CMS Enhanced Patient Appeal Procedures

Doctors must consider the implications of altering a patient’s status. The Centers for Medicare & Medicaid Services (CMS) is suggesting novel retrospective and prospective appeal procedures in compliance with a federal district court order from the District of Connecticut. On December 21, the agency unveiled a proposed rule aiming to institute an appeal mechanism for […]
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How Implementing Site-Neutral Policies Can Help Reduce Healthcare Costs

How Implementing Site-Neutral Policies Can Help Reduce Healthcare Costs

The United States grapples with a healthcare affordability crisis, anticipating a 6.5 percent surge in costs due to inflation next year. Amidst concerns over escalating medical expenses, the deeper roots of these inflated prices often evade attention. Deficient government policies, notably Medicare reimbursement policies, contribute to consolidating the healthcare sector, ultimately driving up costs that […]
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CPT codes play a pivotal role in the transition to value-based care

CPT® codes play a pivotal role in the transition to value-based care

In order for value-based healthcare to succeed, it is imperative that physician practices effectively articulate the medical services and procedures they provide. This underscores the vital role of the Current Procedural Terminology (CPT®) code set in driving the shift towards value-based care. According to the chair of the AMA/Specialty Society Relative Value Scale Update Committee (RUC), […]
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Medicare Advantage Plans: A Positive Experience for Beneficiaries

Medicare Advantage Plans: A Positive Experience for Beneficiaries

Higher satisfaction with problem resolution was observed among beneficiaries who were more inclined to renew their Medicare Advantage plan. Medicare Advantage plans have garnered favorable satisfaction scores, with beneficiaries showing high approval ratings for trustworthiness, operational ease, and coverage adequacy, as outlined in a recent market research study. The 2023 US Medicare Advantage Study encompasses […]
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President’s Efforts to Limit Surprise Medical Bills and Reduce Health Care Expenses

The President administration has announced its intention to restrict the sale of “junk” insurance policies, including short-term plans that may not provide adequate coverage for individuals who are in-between jobs and require temporary health care coverage. These policies have been known to deny basic coverage to policyholders. On Friday, President announced a set of fresh […]
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