At a subcommittee hearing, lawmakers expressed a willingness to legislate prior authorization and "upcoding" practices used by insurers. It's not clear when they might take action in light of a packed ...

Humana has released details about additional, upcoming organizational improvements to encourage a faster prior authorization ...

Inappropriate denials for prior authorization and coverage of medically necessary services are a pervasive problem among certain plans in the Medicare Advantage (MA) program.

CMS issued the 2026 Medicare Physician Fee Schedule, or PFS, proposed rule on July 14.It includes a 0.75% increase to the ...

Humana is taking a second bite at the apple to improve its sunken MA stars, filing an edited complaint with a Texas court on ...

Insurers are likely to propose sharp increases in premiums for Affordable Care Act plans next year, according to a new report ...

Barrett for KFF Health News. Broadcast version by Suzanne Potter for California News Service reporting for the KFF Health ...

On July 15, 2025, the Centers for Medicare & Medicaid Services (CMS) released the Hospital Outpatient Prospective Payment (OPPS) and Ambulatory Surgical Center (ASC) Payment Systems proposed rule for ...

While Medicare Advantage (MA) penetration has skyrocketed, forcing home health providers to adapt their businesses. MA home health utilization, however, ...

The Centers for Medicare & Medicaid Services (CMS) on July 15, 2025, issued the Hospital Outpatient Prospective Payment (OPPS) and Ambulatory ...

Both the Centers for Medicare & Medicaid Services (CMS) and dozens of the nation’s largest insurance companies have revealed upcoming changes to ...

Medicare Advantage could become the default health-insurance program for all older adults. A recent proposal in Congress would automatically enroll older adults in a Medicare Advantage plan and then ...