Tag: Medicare Advantage
Andrea Stark on re-engineering Medicare Advantage
September 8, 2023Liz Beaulieu, Editor
YARMOUTH, Maine – There will be overdue changes to Medicare Advantage in the next year that will make them “a lot more friendly” to HME providers, says Andrea Stark.
Stark, a Medicare consultant and reimbursement specialist with MiraVista, joined the HME News in 10 podcast in August to take a deep dive into the “state of the state” of Medicare Advantage and what’s in store for these plans.
Here’s an excerpt:
‘State of the...
Stakeholders push back against vent denial rates
August 15, 2023Theresa Flaherty, Managing Editor
WASHINGTON – With an “absurd” denial rate as high as 86% for non-invasive ventilators for one major Medicare Advantage plan, industry stakeholders are collaborating with patient advocacy groups to elevate their concerns with CMS.
Confusion around who qualifies for NIVs vs. bi-level devices is nothing new, but recently, it’s gotten worse, says David Chandler, senior director of payer relations for AAHomecare.
“It’s escalated to what I consider...
VGM seeks to streamline MA complaint process
June 26, 2023HME News Staff
WATERLOO, Iowa – VGM & Associates encourages providers to supply the Office for Program Operations and Local Enforcement at CMS with examples of Medicare Advantage organizations denying prior authorizations and claims for several important categories of DME. “We understand the urgency surrounding these issues and have been talking with them about the best process to resolve them,” VGM stated in a recent bulletin. “In addition to those efforts, several of our members have asked...
In brief: MA reform, Invacare credit, health expenditures
June 21, 2023HME News Staff
LOS ANGELES – A new analysis by researchers at the University of Southern California warns that overpayments to Medicare Advantage plans now exceed 20%, or $75 billion annually, underscoring the urgent need for reform.
Researchers with the USC Schaeffer Center for Health Policy & Economics found that the millions of beneficiaries in traditional Medicare who have switched to Medicare Advantage plans have lower spending than those with similar health risks. They report this pattern of...
Hunger Games? Used car market, Medicare Advantage both tough markets
June 19, 2023Theresa Flaherty, Managing Editor
I am currently in the market for a new used car, my first in 10 years. While I knew it was coming, the news came as an unwelcome shock because I, too, have heard about the vehicle shortages, high costs and high interest rates that have turned what was already an unpleasant experience, at best, into a Hunger Games-style free-for-all.
Over at my work desk, the big news is the Humana contracts, an exciting opportunity for AdaptHealth and Rotech and a source of dread and anxiety for everyone else...
Researchers call for Medicare Advantage reform
June 19, 2023HME News Staff
LOS ANGELES – A new analysis by researchers at the University of Southern California warns that overpayments to Medicare Advantage plans now exceed 20%, or $75 billion annually, underscoring the urgent need for reform.
Researchers with the USC Schaeffer Center for Health Policy & Economics found that the millions of beneficiaries in traditional Medicare who have switched to Medicare Advantage plans have lower spending than those with similar health risks. They report this pattern of...
Heartland Conference: How to ‘outperform stress,’ why MA plans are here to stay, what makes resupply promising
June 14, 2023Liz Beaulieu, Editor
WATERLOO, Iowa – VGM kicked off its 2023 Heartland Conference on Tuesday with a keynote session from Adam Markel on “change proof resilience,” an apt topic for HME provider attendees navigating the fast-paced health care environment.
Markel, who is a former lawyer turned researcher, speaker and author of a number of books, including Change Proof, said resilience, contrary to what we think, is not about Rocky-like endurance.
“That’s the grit model,”...
Ramp up to new Humana contract raises questions
June 9, 2023Theresa Flaherty, Managing Editor
YARMOUTH, Maine – HME providers say getting locked out of Medicare Advantage contracts could be one of the biggest threats they face.
Humana in mid-May announced it had awarded capitated care contracts to AdaptHealth and Rotech Healthcare to provide certain home medical equipment services to its Medicare Advantage HMO members.
“A lot of (big payers) won’t let us into the network – I think a lot of companies are experiencing that,” said Brian...
AdaptHealth sees Humana deal as ‘starting ground’
May 19, 2023Theresa Flaherty, Managing Editor
PLYMOUTH MEETING, Pa. – AdaptHealth’s new partnership with Humana to provide home medical equipment to about 1 million Medicare Advantage HMO members could lay the groundwork for bigger things in the future, says CEO Steve Griggs.
Humana in mid-May announced it had awarded capitated care contracts to AdaptHealth and Rotech Healthcare to provide home medical equipment services to its Medicare Advantage HMO members.
“What’s exciting for us is, because it’s...
In brief: Invacare delay, Philips recall, Rehab Medical expansion, Medicare Advantage payments
April 7, 2023HME News Staff
ELYRIA, Ohio – Invacare has filed a Form NT 10-K notifying the U.S. Securities and Exchange Commission that it is unable to file its annual report for the period ending Dec. 31, 2022, within the prescribed time period due to its Chapter 11 bankruptcy filing.
“Due to the considerable time and resources the company’s management is devoting to the Chapter 11 cases, and the need to prepare and review the disclosures required in the Form 10-K as a result of the Chapter 11 cases,...