Tag: Medicare Advantage plans

Medicare Advantage Plans and the Two-Midnight Rule

Medicare Advantage Plans and the Two-Midnight Rule

Medicare Advantage plans hold up their end of the contract with CMS, and provide, at a minimum, a fair reimbursement for services delivered. The physician advisor is a fast-growing specialty that has evolved into so much more than someone who performs endless chart reviews for observation status determinations, medical necessity reviews, peer-to-peer conversations with payors, […]
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Newly expanded supplemental benefits in Medicare Advantage grew 43% for 2022

Newly expanded supplemental benefits in Medicare Advantage grew 43% for 2022

Along with that growth, the number of plans offering more than one benefit increased 15%, from 175 to 202. The findings show that under the Centers for Medicare and Medicaid Services’ reinterpretation of “primarily health-related” benefits, supplemental benefit offerings in Medicare Advantage – such as home-based palliative care, in-home support services, caregiver support and therapeutic […]
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early-warning-hospital-billing-errors-portend-bleakness

Early Warning: Hospital Billing Errors Portend Bleakness

Hospitals across the nation are seeing lower profits, and it’s all because of a sudden tsunami of Medicare and Medicaid provider audits. Whether it be by Recovery Audit Contractor (RACs), Medicare Administrative Contractors (MACs), Unified Program Integrity Contractors (UPICs), or otherwise, hospital audits are rampant. Billing errors, especially “supposed bundling,” are causing a high rate […]
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AHA Calls for Medicare Advantage Inclusion in Prior Authorization Rule

AHA Calls for Medicare Advantage Inclusion in Prior Authorization Rule

The American Hospital Association (AHA) has asked CMS to include Medicare Advantage organizations in its proposed rule that would streamline the prior authorization process and reduce patient care delays. In December 2020, CMS released a notice of proposed rulemaking about improving prior authorization, following past administrative and clinician struggles. If the rule is finalized, there […]
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More Medicare Advantage plans will offer nonmedical benefits in 2022, finds Avalere

More Medicare Advantage plans will offer nonmedical benefits in 2022, finds Avalere

  More plans will offer meals, nutrition, transportation or in-home support services at a $0 premium in 2022. Ahead of the annual election period, which began on October 15, the Centers for Medicare and Medicaid Services published information on MA and Part D plan (PDP) premiums, benefit offerings and star ratings. Avalere analyzed that data […]
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87 Contracts Score 5 Stars on 2022 Medicare Advantage Star Ratings

87 Contracts Score 5 Stars on 2022 Medicare Advantage Star Ratings

On average, Medicare Advantage-prescription drug plans scored 4.37 stars for the 2022 Medicare Advantage Star Ratings. Over nine in ten Medicare Advantage-prescription drug plans (94.26 percent) received a 3.5 star rating or higher on the 2022 Medicare Advantage Star Ratings, with an average star rating of 4.37 stars, CMS announced. In contrast, in 2019 over […]
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Prime Healthcare hospitals cut ties with UnitedHealthcare, citing low reimbursement

Prime Healthcare hospitals cut ties with UnitedHealthcare, citing low reimbursement

Prime’s New Jersey hospitals will continue to honor the rates and services in the agreements until the end of the cooling off period. The decision impacts Saint Clare’s Health in Denville, Dover and Boonton, Saint Michael’s Medical Center in Newark, and Saint Mary’s General Hospital in Passaic. Dr. Sonia Mehta, regional CEO and chief medical […]
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UnitedHealthcare loses Medicare Advantage overpayment suit

UnitedHealthcare loses Medicare Advantage overpayment suit

Dive Brief: A federal appeals court has ruled against UnitedHealthcare, the biggest private payer in the U.S., and reversed a 2018 decision overturning Medicare’s overpayment rule requiring insurers to refund reimbursement to CMS within 60 days if they learn a diagnosis lacks medical record support. UnitedHealthcare argued in court in November the overpayment rule was […]
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