Service (FFS) estimated improper payment rate was 6.55%, or $28.83 billion, compared to the FY 2024 reported rate of 7.66%, ...

CMS reports Medicare fee-for-service improper payments at $28.8 billion in fiscal 2025, with a 6.55% improper payment rate, down from 2024.

The Centers for Medicare and Medicaid Services (CMS) has implemented prior authorization requirements for certain traditional ...

It’s March, which means one thing for sports fans: the madness of the NCAA men’s and women’s basketball tournaments. However, to folks in the regulatory world, it also means something else too: the ...

Original Medicare primarily operates on a fee-for-service (FFS) system, billing for each service provided. Some Medicare Advantage (Part C) plans also use this payment model via private FFS plans.

Private Fee-for-Service (PFFS) plans are one of four main types of Medicare Advantage policies that private insurance companies administer. The plans have specific rules relating to costs paid to ...

As described in a previous Regs & Eggs blog post, certain Medicare “extenders” got tied to the government shutdown. These policies are temporary in nature, but Congress routinely extends them every ...

The authors of the study and the editorial note that a primary limitation on these findings is the concentration of Medicare FFS patients, who are likely to experience higher levels of illness and ...

Medicare Advantage (MA) is privately administered health care insurance for seniors and persons with disabilities. The program has grown rapidly and now covers more than half of Medicare-eligible ...