Current & Emerging Payment Models
The Centers for Medicare & Medicaid Services announced (https://www.cms.gov/priorities/innovation/innovation-models/lead) Jan. 15 that it will host a webinar Jan. 29 on its new accountable care organization model, the Long-term Enhanced ACO Design Model.
The Centers for Medicare & Medicaid Services Dec. 23 introduced a new drug pricing model, BALANCE, for Medicare Part D and Medicaid beneficiaries.
This Trailblazer explores how hospitals are improving revenue cycle performance by aligning technology, people and processes.
The Centers for Medicare & Medicaid Services announced Dec. 18 that it will launch a voluntary payment model designed to broadly reach more health care providers who have not joined accountable care organizations, including those with specialized patient populations and others such as small,…
The Centers for Medicare & Medicaid Services Innovation Center will launch a new, outcome-aligned payment model for providers offering technology-supported care to individuals with Original Medicare for managing common chronic conditions. The Advancing Chronic Care with Effective, Scalable…
Aetna’s new “level of severity inpatient payment” policy is now set to take effect Jan. 1, 2026, the company recently announced, along with providing additional details about the policy. The policy was supposed to take effect Nov. 15.
The Centers for Medicare & Medicaid Services is launching a new initiative for state Medicaid programs to purchase prescription drugs at prices aligned with those paid in other countries, known as most-favored-nation pricing.
The Centers for Medicare & Medicaid Services has released an operational guide for Medicare-enrolled providers and suppliers on the Wasteful and Inappropriate Service Reduction model.
Automating health care insurance claims management with AI-powered tech can speed denials resolution - TrailBlazers
The Centers for Medicare & Medicaid Services has issued the 2025-2026 Medicaid Managed Care Rate Development Guide for states to use when setting managed care capitation rates for the rating periods between July 1, 2025, and June 30, 2026.