“Medicare Advantage plans have a unique and growing opportunity to address the needs of socioeconomically vulnerable populations and improve their health,” reports America’s Health Insurance Plans. More plans for individuals with low incomes, as well as targeted SDOH investments and initiatives, round out carrier approaches. On the benefits side, offerings such as meals, transportation, […]
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 […]
Advanced primary care can help employers control costs and coordinate care, but many employers do not know how to start and scale such a solution in their employer-sponsored health plans, according to a report from the Duke-Margolis Center. Primary care is an essential part of preventing high-cost health conditions among employees. However, only slightly more […]
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 […]
The industry group urged lawmakers to stop proposed cuts to Medicare payment for physicians as outlined in recent legislation and regulation. Medical groups are urging Congress to prevent significant cuts to Medicare payment that could be triggered by recent spending bills and a proposed rule from CMS. In a letter to Congressional leaders, AMGA (American […]
A new interim final rule with comment period ensures Medicare reimbursement for the administration of a COVID-19 vaccine and provider use of innovative treatments for the novel coronavirus. The rule released last night states that Medicare will pay providers $28.39 for the administration of a single-dose COVID-19 vaccine. In the event an approved COVID-19 vaccine requires multiple […]
86% of medical group practices in an MGMA report said regulatory burden rose in the last year, with prior authorizations and the Quality Payment Program adding to that burden. A vast majority of medical group practices experienced growing regulatory burden in the last year, with prior authorizations and Medicare’s Quality Payment Program topping their list […]
The Centers for Medicare & Medicaid Services (CMS) knows that a significant amount of money is being overpaid to insurance companies in the Medicare Advantage program, but they have yet to recover these overpayments. That’s about to change. CMS says it will increase the audits being performed on Medicare Advantage risk-adjusted code submissions and apply […]
The Medicare Advantage (MA) program, which allows Medicare beneficiaries to voluntarily enroll in a private plan that administers health benefits, was established by the Balanced Budget Act (BBA) of 1997 as a vehicle to bring private-sector competition and innovation to Medicare beneficiaries. When the program was announced, the goal was to create greater competition on […]
Medicare Advantage Plan contracts are “take-it-or-leave-it” agreements Many questions are swirling about regarding Medicare Advantage Plan (MAP) denials asking what to do about the increasing number and given reasons. I’ve heard or read some amazing stories where payers have gone to astounding lengths to deny claims. Answers are also swirling about based on understandings of […]