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Tag: Medicare Advantage


HME Newspoll

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Newspoll: When it comes to revenue, many providers seeing red

June 21, 2024Theresa Flaherty, Managing Editor

YARMOUTH, Maine – June marks the midpoint of the calendar year and so far, it’s been a financial disappointment say 65% of respondents to a recent HME Newspoll.  “2024 has been a challenging year,” wrote one poll respondent. “Despite our growth in volume and workforce, we have encountered significant obstacles. We have faced difficulties in contracting, with closed insurance panels, struggled with low reimbursement rates, and dealt with high equipment costs.”  Reimbursement...

Change Healthcare, Cyberattack, Home Medical Equipment (HME), Medicare Advantage


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Dan Fedor

News

Medicare Advantage: Industry fights back

June 14, 2024Liz Beaulieu

WATERLOO, Iowa – There’s a renewed call to submit data that demonstrates Medicare Advantage plans are wrongly denying coverage for home medical equipment, and during a panel at the VGM Group’s Heartland Conference on June 11, stakeholders shared a prime example.  Stakeholders have been encouraging providers, where applicable, to submit claims through the prior authorization process for traditional Medicare, even for Medicare Advantage patients. If Medicare approves the claim...

Heartland Conference, Medicare Advantage, VGM Group


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Also Noted

Lawmakers reintroduce prior auth bill 

June 13, 2024HME News Staff

CHICAGO – Members of the House of Representatives and Senate have reintroduced bipartisan legislation to streamline and standardize the use of prior authorization within Medicare Advantage. The Improving Seniors’ Timely Access to Care Act, which has the support of the American Medical Association, features targeted policy changes to reduce the scored cost of the legislation, an obstacle last Congress. “We thank the sponsors for writing the bill so it will attract even more support,”...

Medicare Advantage, Prior Authorization


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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...

Kalogon, Medicare Advantage, Orthotics


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Also Noted

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...

AAHomecare, Medicare Advantage


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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...

Medicare Advantage, Tomorrow Health


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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...

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

News

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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