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Tag: Medicare Advantage

On the Editor's Desk

I have questions

November 21, 2023Liz Beaulieu, Editor

YARMOUTH, Maine – One of the most interesting takeaways from the HME News Business Summit in Charlotte, N.C., Oct. 22-24, was just how much commercial insurers care about patient satisfaction.   Brad Heath, an executive vice president with AdaptHealth, was part of a panel at the Summit on disruptive partnerships with payers. AdaptHealth, along with Rotech Healthcare, as we all know, has a contract with Humana to provide certain home medical equipment services to its Medicare Advantage...

AdaptHealth, HME News Business Summit, Humana, Medicare Advantage

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Medline responds to food-as-medicine movement 

November 20, 2023HME News Staff

NORTHFIELD, Ill. – Medline has launched a new Food Benefit Solution that allows Medicare Advantage and Managed Medicaid Organizations to offer locally sourced and fresh produce, healthy groceries and prepared meals – delivered directly to member homes – as an added supplemental benefit.  “Access to a food benefit can help members meet their nutritional needs, encourage healthier eating habits, and manage and prevent chronic diseases,” said Amy Rogers, BSN, RN,...

food benefit, Medicare Advantage, Medline

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Where’s the Advantage?

November 13, 2023Theresa Flaherty, Managing Editor

On a semi-regular basis, Editor Liz Beaulieu asks me: “Are HME providers for or against prior auths?”  I then try to remember where things stand on that particular issue before helpfully responding: “Both, I think?”  So, we went directly to the source. Our October HME Newspoll (See story page 3) asked: “How do you feel about prior auths?”   Results were mixed, with 58% of respondents saying, “No thanks!” due to the heavy...

Medicare Advantage

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‘Heavy handed’ Medicare Advantage tests providers

November 3, 2023Liz Beaulieu, Editor

YARMOUTH, Maine – The majority of respondents to the HME Newspoll say the number of patients they care for that are covered by Medicare Advantage plans has increased more than 10% in the past year – and they’re worried.  The trend is no surprise, with more than half of eligible Medicare beneficiaries enrolled in these plans this year, with a projected 62% by 2033.  “Medicare Advantage plans have disrupted the health care sector,” wrote one respondent....

home medical equipment, Medicare Advantage

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AAH, ALS association send NIV letter to CMS

October 12, 2023HME News Staff

WASHINGTON – AAHomecare and the ALS Association continue to press their case with CMS that Medicare Advantage plans are improperly denying claims and imposing stricter coverage criteria for non-invasive ventilators than Medicare allows.  In an Oct. 4 letter to Kathryn Coleman, director, Medicare Drug & Health Plan Contract Admin Group for CMS, AAHomecare and the ALS Association share examples of MA plans that are “ignoring physician's orders and instead use excessive prior...

AAHomecare, ALS Association, Medicare Advantage, Non-invasive ventilators

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Cigna pays $172M to resolve FCA allegations

October 4, 2023HME News Staff

PHILADELPHIA – Cigna has agreed to pay $172 million to resolve allegations that it violated the civil False Claims Act by submitting and failing to withdraw inaccurate and untruthful diagnosis codes for its Medicare Advantage Plan enrollees to increase its payments from Medicare.   Cigna will pay about $135 million to resolve the allegations, with the remaining $37 million resolving allegations related to unsupported diagnoses for MA beneficiaries arising from Cigna’s home visit...

Cigna, False Claims Act, Medicare Advantage

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In brief: Philips refutes claims, MA premiums remain stable, NCPA supports CVS lawsuit 

September 29, 2023HME News Staff

AMSTERDAM – Philips disagrees with “characterizations” in recent articles that the company knew for several years about problems with certain ventilators and sleep apnea devices.  ProPublica and the Pittsburgh Post-Gazette on Sept. 27 published an article saying that Philips knew about a dangerous breakdown inside its widely used ventilators and sleep apnea machines but waited years before recalling the devices in 2021.  In a statement, Philips said it had previously...

CPAP Recall, Lawsuit, Medicare Advantage, National Community Pharmacists Association (NCPA), Philips

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CMS: Medicare Advantage, drug programs to remain stable in 2024 

September 27, 2023HME News Staff

WASHINGTON – Average premiums, benefits and plan choices for Medicare Advantage and the Medicare Part D prescription drug program will remain stable in 2024, according to CMS.  The announcement precedes the upcoming Medicare Open Enrollment period, which begins Oct. 15, 2023, to help people with Medicare determine the best Medicare coverage option for their health care needs.  “A top priority for CMS is to protect and strengthen the Medicare program for people with Medicare,...

CMS, Medicare Advantage, Premiums, prescription drug plans

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Andrea Stark


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...

Andrea Stark, HME News in 10, Medicare Advantage, Podcast

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Craig Douglas

Specialty Providers

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...

AAHomecare, Denial Rate, Medicare Advantage, Ventilator, VGM

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