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Leah K.Verified PurchaseMar 15, 2026 Five weeks in and friends have asked what I am doing differently

Respondents broadly identified three primary reasons for near payment equivalence: Statutory and regulatory provisions that limit out-of-network payments to traditional Medicare rates, De facto budget constraints that MA plans face because of the need to compete with traditional Medicare and other MA plans, and A market equilibrium that permits relatively lower MA rates as long as commercial rates remain well above the traditional Medicare rates

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Consistent with our current policy, for CY 2026, we proposed to retain services within New Technology APC groups until we obtain sufficient claims data to justify reassignment of the service to an appropriate clinical APC