Tag: Medicare Advantage
In brief: Orthotics fraud, Medicare Advantage data, Kalogon seed
May 31, 2024HME News Staff
WASHINGTON – The Office of Inspector General says there are still issues related to CMS’s oversight of off-the-shelf braces, including providers that ordered braces for enrollees for whom there was no history of a treating relationship.
The OIG also found new suppliers located in geographic areas with known Medicare fraud; Medicare paid more than private payers for OTS braces; and suppliers used prohibited solicitation to contact enrollees.
“These issues continue...
AAH makes recs on Medicare Advantage
May 30, 2024HME News Staff
WASHINGTON – AAHomecare has responded to a CMS request for information on Medicare Advantage data with recommendations to improve transparency in these plans. The association’s recommendations include:
Require MA plans to publish data that demonstrates they provide sufficient access to care and patient choice, including measures of beneficiary satisfaction and complaints, as well as the number of in-network DME suppliers by product category and geography.
Require MA...
In brief: CMS presses MA plans, Tomorrow Health builds growth team
April 10, 2024HME News Staff
WASHINGTON – CMS has finalized policies that it says will continue to strengthen protections and guardrails to ensure Medicare Advantage and Medicare Part D prescription drug plans best meet the needs of enrollees.
The Contract Year 2025 Medicare Advantage and Part D final rule will:
Establish a set amount a plan can compensate an agent or broker to protect Medicare Advantage and Part D plan enrollees and prospective enrollees from anti-competitive steering.
Require...
CMS continues to press MA plans
April 9, 2024HME News Staff
WASHINGTON – CMS has finalized policies that it says will continue to strengthen protections and guardrails to ensure Medicare Advantage and Medicare Part D prescription drug plans best meet the needs of enrollees.
The Contract Year 2025 Medicare Advantage and Part D final rule will:
Establish a set amount a plan can compensate an agent or broker to protect Medicare Advantage and Part D plan enrollees and prospective enrollees from anti-competitive steering.
Require...
In brief: Industry’s reimbursement uncertainty, MedPAC’s MA takedown, CMS’s Change flexibilities
March 20, 2024HME News Staff
WASHINGTON – Industry stakeholders are on the hunt for another vehicle for their legislation to extend the 75/25 blended Medicare reimbursement rate in non-rural areas through 2024.
AAHomecare reports that its lobbyists and HME advocates on the Hill have indicated that reimbursement relief will not be included in a second segment of appropriations language that must pass Congress by March 22 to prevent another government shutdown.
“We will continue to look for other...
MedPAC on MA: ‘Major overhaul’ needed
March 19, 2024HME News Staff
WASHINGTON – When accounting for favorable selection of enrollees in Medicare Advantage and higher coding intensity, Medicare spends approximately 22% more for MA enrollees than for FFS Medicare enrollees, a difference that translates into a projected $83 billion in 2024, according to an annual report from the Medicare Payment Advisory Committee (MedPAC).
Additionally, premiums will be about $13 billion higher in 2024 because of higher MA spending, according to MedPAC’s “2024...
CMS piles on prior auth requirements
February 7, 2024Liz Beaulieu, Editor
YARMOUTH, Maine – A rule finalized in January is CMS’s latest bid to fine-tune the prior authorization process for Medicare Advantage plans and other payers to increase efficiency and transparency.
The agency in January finalized a rule requiring MA plans and other payers like Medicaid and Medicaid managed care to send prior authorization decisions within 72 hours for urgent requests and seven calendar days for standard requests. For some payers, CMS says, this cuts the current...
HCSC buys Cigna’s MA business
February 5, 2024HME News Staff
CHICAGO – HCSC has signed a definitive agreement with the Cigna Group to buy its Medicare Advantage, Medicare Supplemental Benefits, Medicare Part D and CareAllies businesses for $3.3 billion.
HCSC, an independent licensee of the Blue Cross Blue Shield Association, bills itself as the largest customer-owned health insurer, serving more than 22 million people across the United States.
“The acquisition will bring many opportunities to HCSC and its members — including...
In brief: MA payments, tech stage, device risk, Cardinal acquisition
February 2, 2024HME News Staff
WASHINGTON – CMS has released a Calendar Year 2025 Advance Notice for the Medicare Advantage and Medicare Part D Prescription Drug Programs that would pave the way for payments to MA plans to increase on average by 3.7%, or more than $16 billion, from 2024 to 2025.
“CMS continues to ensure that Medicare Advantage and Part D prescription drug plans remain strong, stable and affordable offerings,” said CMS Administrator Chiquita Brooks-LaSure. “The Advance Notice upholds...
CMS releases proposed payment updates for Medicare Advantage
February 1, 2024HME News Staff
WASHINGTON – CMS has released a Calendar Year (CY) 2025 Advance Notice for the Medicare Advantage (MA) and Medicare Part D Prescription Drug Programs that would pave the way for payments to MA plans to increase on average by 3.7%, or more than $16 billion, from 2024 to 2025.
“CMS continues to ensure that Medicare Advantage and Part D prescription drug plans remain strong, stable and affordable offerings,” said CMS Administrator Chiquita Brooks-LaSure. “The Advance...