Tag: Medicare Advantage

MINNEAPOLIS – UnitedHealthcare recently notified HME providers that it is delaying the implementation of its new capitated arrangement with Synapse Health for standard DME in Georgia and North Carolina, AAHomecare has reported.  The arrangement, which impacts the insurer’s Medicare Advantage plan members enrolled in HMO and PPO plans in the two states, will now go into effect Sept. 1 instead of Aug. 1 to allow more time for providers to familiarize themselves with new processes...

HME stakeholders have been fighting Medicare Advantage for some time, particularly when it comes to these plans not following Medicare policy and coverage for complex rehab technology and non-invasive ventilators, two product categories for patients with the greatest needs.  At the Heartland Conference in June, there was even a panel discussion titled “Dealing with Medicare DISadvantage Plans - Are You Ready, Martha?” Stakeholders continue to take it up a notch.  AAHomecare...

YARMOUTH, Maine – There’s a lot of noise right now around improving the prior authorization process for Medicare Advantage plans and the HME industry needs to make sure it continues to add its voice to the conversation, say stakeholders.  Most recently, in June, members of the House of Representatives and the Senate reintroduced bipartisan legislation to streamline and standardize the use of prior authorization for these plans. The Improving Seniors’ Timely Access to Care...

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...

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...

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,”...

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...

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...

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...

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...