Medicare Open Enrollment is a critical period for millions of Americans, running annually from October 15th to December 7th. During this time, Medicare beneficiaries have the opportunity to review and make changes to their health and prescription drug plans for the upcoming year, with new coverage taking effect on January 1st. For health payers, this […]
Enrolling in Medicare can feel like navigating a maze of paperwork and deadlines. This comprehensive guide aims to simplify the process, focusing specifically on the new Medicare enrollment application. We’ll break down the different parts of the application, explain eligibility requirements, discuss enrollment periods, and offer tips for a smooth and successful enrollment experience. Understanding […]
Prior authorization, the requirement for pre-approval from your insurer for certain services, is a common practice in both Original Medicare and Medicare Advantage (MA) plans. While it helps manage utilization and costs, it can also be frustrating, especially when a request is denied. A 2023 study by health policy research revealed the increasing prevalence of […]
Medicare coverage is the federal health insurance program for Americans 65 and older, as well as younger individuals with long-term disabilities. It covers a wide range of medical services, including hospitalizations, doctor’s visits, prescription drugs, and specialized care like skilled nursing, home health, hospice, and preventive services There are two primary ways to receive Medicare […]
Medicare Advantage (MA) has become a dominant force in the Medicare landscape, accounting for over 54% of overall Medicare enrollment. This trend is expected to continue, with penetration rates projected to reach 64% by 2033. However, the future of the Medicare Advantage market is not without its challenges. The Slowdown Begins While MA has experienced […]
Don’t allow preventable error to disrupt your revenue cycle. In order for a claim to be considered clean, it must contain all necessary information for the payer to fully process it without requiring further investigation or development. This includes being submitted within the designated timeframe, passing all necessary reviews, having any required medical evidence or […]
CMS wants to identify bad actors -– even if they are or have been affiliated with a legitimate provider. On Sept. 5, the Centers for Medicare & Medicaid Services (CMS) issued a new final rule. There was not really a proposed rule to which comments and suggestions could be made; there were Federal Register entries […]
CMS’ proposed 2020 Medicare Physician Fee Schedule includes substantial changes to the rules for obtaining and maintaining Medicare billing privileges. A one-paragraph statement in the proposed rule calls for applying Medicare enrollment approval and revocation rules for opioid treatment programs to all physicians and other eligible professionals. The proposal would allow CMS to revoke Medicare […]