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Tag: Medicare Advantage


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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...

Change Healthcare, Cyberattack, Medicare Advantage, Medicare Payment Advisory Commission (MedPAC), reimbursement relief


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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...

annual report, Medicare Advantage, Medicare Payment Advisory Commission (MedPAC)


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David Chandler

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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...

Andrea Stark, David Chandler, Medicare Advantage, Prior Authorization


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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...

Blue Cross Blue Shield, Cigna, HCSC, Medicare Advantage, Mergers & Acquisitions (M&A)


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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...

Advanced Diabetes Supply, Cardinal Health, FreeStyle Libre, Medicare Advantage, MK Battery, Rolko North America


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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...

Medicare Advantage


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In brief: Aeroflow leadership, Hill-Rom settlement, MA transparency 

January 31, 2024HME News Staff

ASHEVILLE, N.C. – Aeroflow Health has announced a number of leadership appointments, following its recent rebrand.  The company has appointed Scott Sonnone, previously CFO, as president; Ryan Bullock, previously COO, as chief strategy officer; and Lauren Bennett, previously vice president of Aeroflow Sleep, as COO.   “I’m very proud of the growth Aeroflow Health has exhibited and am excited to continue expanding the team and advancing its mission alongside Lauren...

Aeroflow Health, Hill-Rom, Medicare Advantage


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CMS seeks increased transparency for MA plans 

January 29, 2024HME News Staff

WASHINGTON – CMS has released a request for information (RFI) to solicit feedback from the public on how best to enhance Medicare Advantage data capabilities and increase public transparency.  The agency says transparency is especially important now that MA plans have grown to more than 50% of Medicare enrollment, and the government is expected to pay these plans more than $7 trillion over the next decade.  “Americans with Medicare who have managed care plans called Medicare...

CMS, Medicare Advantage, Request for information, transparency


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In brief: Senators’ demands, F&P’s new execs, Belluscura’s green light

December 21, 2023HME News Staff

WASHINGTON – A group of senators has asked CMS to collect and publish more Medicare Advantage data to help lawmakers and regulators better understand the impact of these plans.  AAHomecare provided the following analysis of the group's new letter to CMS Administrator Chiquita Brooks-Lasure:  The senators cite “concerning trends” in Medicare Advantage and point to a 2019 HHS OIG study that “found that among requests MA plans denied, 13% of prior...

Belluscura, Dexcom, Fisher & Paykel Healthcare, Medicare Advantage, woman of the year


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Senators press for MA data

December 21, 2023HME News Staff

WASHINGTON – Sens. Marsha Blackburn, R-Tenn., Bill Cassidy, R-La., Catherine Cortez Masto, D-Nev., and Elizabeth Warren, D-Mass., have asked CMS to collect and publish more Medicare Advantage data to help lawmakers and regulators better understand the impact of these plans in a new letter to CMS Administrator Chiquita Brooks-Lasure.  AAHomecare stated in a recent bulletin:  The senators cite “concerning trends” in Medicare Advantage and point to a 2019 HHS OIG study...

Medicare Advantage


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