Ilene MacDonald

Revenue cycle success increasingly depends on an organization's ability to access, exchange, validate, and use data across a growing health care ecosystem. Documentation quality, coding accuracy, and compliant billing practices have supported…

The rules of health care quality are changing fast, and the biggest shift is simple to say but harder to execute. Our latest episode focuses on this fundamental shift in health care quality performance, the future of digital quality, and the…

In our latest episode, we break down the biggest findings from Reveleer's "The State of Technology in Value-Based Care 2026," a report based on a survey of 200 senior payer and provider executives. During this 26-minute discussion, Reveleer President…

A new KFF brief offers an overview of premiums and benefits in 2026 Medicare Advantage (MA) plans based on data from the Centers for Medicare & Medicaid Services’ Landscape and Benefits files.

A new study by Deft Research uncovers how Medicare members use digital health tools provided by their insurers, their providers, and other third parties to manage their health and navigate their coverage.

A U.S. District Court judge from Massachusetts has blocked major revisions to the nation’s childhood vaccine schedule and suspended members of the reorganized Advisory Committee on Immunization Practices (ACIP).

The Trump administration on Wednesday announced a major new program to curb fraud in Medicare and Medicaid, unveiling a series of aggressive oversight and enforcement measures aimed at protecting patients, strengthening program integrity, and reducing federal spending.

Gateway Health Plan improperly received an estimated $4.3 million in Medicare Advantage payments after submitting diagnosis codes that federal auditors say were not supported by medical documentation, according to a new compliance audit from the Department of Health and Human Services Office of Inspector General.

More than 1,600 health care professionals traveled to Orlando, Fla. last week for RISE National 2026, a three-day event that offered practical insights on Medicare Advantage, risk adjustment, Star ratings, member experience, and operational excellence.

Medicare Advantage (MA) enrollment topped 35 million as of February 2026, but new data from Centers for Medicare & Medicaid Services (CMS) shows the program entering a period of slower growth as insurers adjust strategies amid rising costs, reduced margins, and regulatory pressure.

The Department of Health and Human Services on Thursday announced plans to radically restructure the department, cutting thousands of full-time jobs, centralizing units, and prioritizing ending the country’s chronic illness epidemic. HHS said the restructuring will save taxpayers $1.8 billion a year.

It will take nearly $95 billion in discretionary funding in fiscal year 2026 to “Make America Healthy Again,” according to the Trump Administration’s budget for the Department of Health and Human Services (HHS).

The Health Equity Index (HEI) reward in the Medicare Advantage Star ratings program was rebranded in the final rate notice released on Monday.

A newly released Office of Inspector General (OIG) audit found that most of the high-risk diagnosis codes that the St. Louis-based Medicare Advantage (MA) organization submitted to the Centers for Medicare & Medicaid Services didn’t comply with federal requirements.

The agency said the move is part of the administration’s crackdown on fraud, waste, and abuse in the Medicare program.

In this episode of RISE Radio, we share an excerpt from the April 29 RISE webinar featuring Ana Handshuh, principal at CAT5 Strategies, and Melissa Smith, founder of Newton Smith Group, as they walk through the 2027 Medicare Advantage Final Rule.This…

In this episode of RISE Radio, we share an excerpt from the April 29 RISE webinar where Ana Handshuh, principal at CAT5 Strategies, and Melissa Smith, founder of Newton Smith Group, walk through the 2027 Medicare Advantage Final Rule.

A new report from UnidosUS, a Latino civil rights and advocacy group, warns that the federal policy changes are poised to reverse 14 years of progress in Latino health coverage and urges Congress to reverse the policy decisions.

RISE summarizes recent regulatory-related headlines and reports.

A new machine-learning–driven risk-adjustment model could significantly reshape how Medicare Advantage (MA) plans are paid—and potentially save Medicare billions in overpayments each year.