Differential coding by Medicare Advantage plans appeared to have pushed their risk scores higher than traditional Medicare's scores. Those greater risk scores led to $33 billion in extra revenue for ...

Differential coding in MA plans results in higher risk scores and increased payments compared to TM, with significant insurer variation. UnitedHealth Group's risk scores were significantly higher than ...

Numerous studies show that employer plans pay providers significantly more than Medicare, but less is known about prices in nongroup plans sold both on and off the Marketplaces established by the ...

Over 35 million prior authorization requests were submitted to Medicare Advantage insurers in 2021, according to a new report from the Kaiser Family Foundation (KFF). Two million of these requests, or ...

According to a Kaiser Family Foundation analysis, 22% of Medicare Part D drug spending in 2021 went towards the 10 top-selling prescription drugs alone. In 2021, the 10 top-selling prescription drugs ...

The Direct Contracting Model saved Medicare $70 million in 2021 as the Biden administration plans a major overhaul to the value-based care program next year. Recently released data from the Centers ...

Fee-for-service Medicare Part B expenditure on prescription medicines amounted to more than $30 billion US dollars (USD) in 2019. 1 By spending, four of the top 10 drugs within Part B were biologic ...