Medicare Advantage 2026: Key Changes in Billing and Compliance Effective June 3
What Changed
Action required by
June 3, 2025
Review the Action Required section below and ensure your team has completed all compliance steps before this date.
What Changed
The Medicare Advantage payment system is undergoing significant changes effective June 3, 2025, as outlined in the Federal Register Final Rule (Policy ID: FR-2025-06008). These changes involve a shift in reimbursement methodologies for Medicare Advantage plans, requiring more detailed reporting of services to enhance risk adjustment accuracy and ensure payments reflect actual care delivered. Additionally, the rule modifies formulary requirements for Medicare Part D plans to provide more comprehensive coverage for high-cost medications.
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Content summarized from publicly available federal publications including CMS, MAC contractors, and the Federal Register. CLV Intelligence is not affiliated with or endorsed by any government agency. This is not legal or medical advice.