The model will leverage AI and machine learning for prior authorization of services vulnerable to fraud or inappropriate use, CMS says.

CMS has released a proposed rule on home health and DME that includes new policies for the next round of its national competitive bidding program. Those provisions include new rate-setting methodologi ...

Patients with chronic respiratory failure who meet usage criteria will have more access to respiratory assist devices.

“It’s the exact opposite of how we should be helping people,” said Lister. “We should aspire to provide health care services ...

The Trump administration aims to issue a rule empowering regulators to “forcefully” go after companies that don’t share drug ...

Rather than waiting for stalled Congressional efforts to enact so-far elusive Medicare policy changes, states could pursue ...

RVUs were developed by the Center for Medicaid and Medicare Services (CMS) ... 99214-Moderate: 1.00: 1.07: 0.04: 2.21: Tables. Critical Questions to Ask Who are our customers?

The go-broke dates for Medicare and Social Security’s trust funds have moved up as rising health care costs and new ...

The Centers for Medicare & Medicaid Services June 13 announced it approved state plan amendments to expand Medicaid access to care for tribal communities in six states: Minnesota, New Mexico, Oregon, ...

The purpose of this notice is to clarify the MaineCare Benefits Manual (MBM), Chapter I, Section 1, Rounding Rule. MBM Chapter I, Section 1.03-8 (J) advises how to apply the Rounding Rule when partial ...

The June report comes two months after MedPAC recommended that Congress reduce Medicare fee-for-service home health payments by 7%, the same rate cut MedPAC advised in 2024. “Our review indicates that ...

The Centers for Medicare & Medicaid Services (CMS) is the federal agency that oversees health coverage programs like Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).