Medicare Advantage Organizations Overturned 75% of Their Denials

BHM Healthcare Solutions

Editor’s Note: Medicare Advantage organizations (MAOs) continue to do a poor job of maintaining accurate provider directories—and it’s landing some in hot water with the federal government. Financial Medicare and Medicaid Medicaid Medicare payment models Value Based Payments

Study: More Medicare Patients Dying At Home

BHM Healthcare Solutions

Editor’s Note: The growth of Medicare Advantage as a program (it accounts for a third of Medicare enrollees and spending), and the 9.3% The growth of Medicare Advantage as a program (it accounts for a third of Medicare enrollees and spending), and the 9.3%

Medicare Reimbursement for Remote Monitoring Should Drive Adoption (What a long, strange trip it’s been….)

The cHealth Blog

The Centers for Medicare & Medicaid Services (CMS) released the 2018 Physician Fee Schedule about two weeks ago and there is at least one nugget in there that should speed the adoption of remote patient monitoring.

Medicare Hospice Program Vulnerable According to Inspector General Report

BHM Healthcare Solutions

Editor’s Note: The growth of Medicare Advantage as a program (it accounts for a third of Medicare enrollees and spending), and the 9.3% CMS data showed Medicare spending for hospice care rose 81 percent between 2006 and 2016, from $9.2.

Medicare Advantage Plans Grow With Star Ratings

BHM Healthcare Solutions

Editor’s Note: Medicare Advantage organizations (MAOs) continue to do a poor job of maintaining accurate provider directories—and it’s landing some in hot water with the federal government. Financial Medicare and Medicaid Medicaid Medicare payment models Value Based Payments

Medicare Drug Prices Up Despite Decrease in Prescriptions

BHM Healthcare Solutions

Editor’s Note: Increasing costs for prescriptions is creating a long-term financial impact on Medicare Part D and its beneficiaries. Total Medicare reimbursement for all brand-name drugs ballooned 77 percent from 2011 to 2015.

Medicare Drug Prices Up Despite Decrease in Prescriptions

BHM Healthcare Solutions

Editor’s Note: Increasing costs for prescriptions is creating a long-term financial impact on Medicare Part D and its beneficiaries. ” Increasing costs for prescriptions is creating a long-term financial impact on Medicare Part D and its beneficiaries.

RACs returned $214M to Medicare in 2016

FierceHealthIT

Recovery audit contractors (RACs) returned $214 million to the Medicare program in fiscal year 2016. of Medicare expenditures, and one organization says the program is hampered by limits on documentation requests But that represents less than 0.1%

DaVita group to pay $270M to settle Medicare Advantage false claims probe with DOJ

FierceHealthIT

will pay $270 million to resolve claims it provided inaccurate information that caused Medicare Advantage plans to receive inflated Medicare payments A medical care group that is part of dialysis giant DaVita Inc.

Kaiser leads the way in average Medicare Advantage star ratings for 2019

FierceHealthIT

Kaiser's Medicare Advantage plans averaged an overall score of 4.8, boosted by four five-star plans. The remaining large insurers received average star ratings in the mid- to high 3s

Humana expands Medicare Advantage network through new partnership with Heritage

FierceHealthIT

Humana's Medicare Advantage HMO base in southern California will be able to spend more time with providers and receive more robust preventive care as a result of a collaboration with Heritage, the insurer said

OIG: Medicare spent $5.7B on improper payments to inpatient rehab facilities

FierceHealthIT

Of the nearly $7 billion Medicare paid to inpatient rehab hospitals in 2013, $5.7 billion was deemed improper. The watchdog agency recommended that CMS revamp its payment structure for rehab hospitals

CMS to make Medicare Advantage data available to researchers

Morning eHealth

FDA draws strong, mixed reaction — U.S. Digital Service hands QPP back to CMS

Verma, Azar take aim at ‘Medicare for All' proposals

FierceHealthIT

CMS Administrator Seema Verma took another swipe at calls for a “Medicare for All” healthcare system this week, saying expanding those benefits to every American would “dilute” the program

Instead of Medicare for all, consider Medicaid for all, says health law professor

FierceHealthIT

Medicaid for all would bring many of the same benefits as Medicare for all without the political barriers, albeit in fewer states

The Patient As Payor: From Rationing Visits Due to Co-Pays to Facing $370K for Healthcare in Retirement

Health Populi

The latest data on health care costs in retirement was published by EBRI earlier this year in their report , Savings Medicare Beneficiaries Need for Health Expenses: Some Couples Could Need as Much as $370,000, Up from $350,000 in 2016.

Medicare Advantage insurers routinely issue improper payment denials, OIG finds

FierceHealthIT

The HHS Office of Inspector General recommended that CMS become significantly more involved in overseeing Medicare Advantage organizations (MAOs) following a recent report. OIG found that MAOs routinely deny payment for services that should have been provided

Kaiser, Aetna lead the way in NCQA’s Medicare plan ratings

FierceHealthIT

Kaiser and Aetna received high marks for their Medicare plans thanks to an emphasis on prevention. UnitedHealth, Humana and Cigna registered more mediocre ratings

Counties with greatest well-being for seniors cost Medicare thousands less, study finds

FierceHealthIT

Medicare spends nearly $1,000 less per beneficiary in counties where residents are not only healthy, but happy and satisfied with their lives

Telehealth Payments Don’t Meet Medicare Requirements

BHM Healthcare Solutions

Payers are rapidly becoming educated in telehealth and are keen on closing telehealth gap, but need to be mindful of Medicare requirements. Almost a third of telemedicine claims sampled by HHS’ Office of Inspector General did not meet Medicare requirements, resulting in an estimated $3.7

CMS telemedicine expansion could lead to cuts in Medicare base rate

Morning eHealth

What ONC is up to — HITAC task force on interoperability to get underway

Doctors speak out: CMS gets 15,314 comments on proposed physician Medicare changes

FierceHealthIT

The Centers for Medicare & Medicaid Services asked for comments on its proposed physician fee schedule and boy, oh boy, did it get them: 15,314 of them

Technology, Aging and Obesity Drive Healthcare Spending, BEA Finds

Health Populi

Financial health Health Consumers Health costs Health Economics Health policy Heart health Medicare Medicines Mental health Money and health Obesity Personal health finance Pharmaceutical Prescription drugs Prevention Public health Specialty drugs TransparencyThe U.S.

Payer Roundup—Trump rails against Medicare-for-all; Medicare paying nursing facilities more for rehabilitation

FierceHealthIT

The president attacked a Medicare-for-all proposal in an opinion column on Wednesday, and the senator who introduced that bill hit back. Plus, a study suggests for-profit nursing homes are sending patients to therapy at the end of their lives to make more money

CMS data shows ACOs saved Medicare $314M in 2017

FierceHealthIT

New data released by CMS shows ACOs cut Medicare costs by hundreds of millions of dollars after accounting for shared savings payments. The National Association of ACOs said the data proves Track 1 ACOs are generating savings

Medicare Advantage enrollees expected to top 22M in 2019 as premiums drop once again

FierceHealthIT

Medicare Advantage premiums continue to decrease and will reach a three-year low average of $28 in 2019, according to the Centers for Medicare & Medicaid Services. About 46% of enrollees will have zero premium

UnitedHealthcare and AMA clash over Medicare's step therapy changes

FierceHealthIT

UnitedHealth's chief pharmacy officer told FierceHealthcare that CMS' new guidance around step therapy will generate "significant" savings for Medicare Advantage beneficiaries. But AMA said it will lead to "unnecessary red tape" and more denials for patients

AARP to GOP: Leave Medicare Part D doughnut hole alone

FierceHealthIT

Much of the House Republican conference is having second thoughts about closing a doughnut hole for Medicare Part D enrollees, inspiring the AARP to weigh in

HEART Act Targets Medicare Limits on Telehealth

American Well Blog

the Helping Expand Access to Rural Telehealth (HEART) Act targets the Center for Medicare & Medicaid Services’ (CMS) strict limitations on RPM reimbursements in rural areas. Of the 107,000 telemedicine visits for Medicare beneficiaries recorded in 2013, approximately 40,000 of them served rural areas. are on Medicaid and/or Medicare. The post HEART Act Targets Medicare Limits on Telehealth appeared first on American Well.

Racial, ethnic disparities persist in Medicare Advantage

FierceHealthIT

Medicare Advantage plans have been touted as a way to give more control to seniors, but non-minorities may be reaping most of the benefits. A new report finds that minorities enrolled in MA plans are receiving worse clinical care than white patients, following similar studies

Alphabet's $375M investment in Oscar Health will expand insurer into Medicare Advantage

Mobi Health News

Oscar says it uses technology to lower cost: More than 60 percent of member interactions with health systems are virtual

AHA ‘strongly opposes’ interoperability as a Medicare requirement

FierceHealthIT

Responding to a request for information from CMS, the American Hospital Association said it "strongly opposes" revising Medicare Conditions of Participation to include interoperability requirements. The hospital association argued that interoperability is difficult for surveyors to measure and unfairly targets hospitals for data sharing problems that span the healthcare ecosystem

CMS proposes rule to streamline Medicare compliance

FierceHealthIT

CMS took the latest step in its Patients over Paperwork initiative on Monday, issuing a proposed rule that would eliminate or update a slew of regulations deemed “unnecessary, obsolete or excessively burdensome” on providers.

MACRA: Medicare’s Opportunity to Finally Embrace Connected Health Technology

ConnectedHealth

The nation’s healthcare system is in the middle of a major transition – one that, if done well, will have an incredible impact on the lives of millions Americans who rely on Medicare. For a long time, Medicare has had a reputation for being bureaucratic, lethargic, wasteful, and outdated. Further, the Center for Medicare and Medicaid Services (CMS), which administers Medicare, has been slow to incorporate advances in advanced health technology in the program.

Modernizing Medicare to Take Advantage of the Latest Technologies

The CMS Blog

Modernizing Medicare to Take Advantage of the Latest Technologies. Administrator, Centers for Medicare & Medicaid Services. Modernizing Medicare to Take Advantage of the Latest Technologies. Today we are announcing a revision of Medicare’s local coverage determination process, which will pave the way to expanded access to new technologies. However, while medical technology is developing at a rapid pace, Medicare’s payment systems haven’t always been as quick to change.

Payer Roundup—Medicare Advantage thriving under ACA; KFF says support for 'Medicare for All' gains steam with voters

FierceHealthIT

Despite concerns from industry analysts, Medicare Advantage plans are thriving in the wake of the ACA; a new Kaiser Family Foundation poll suggests support for a "Medicare for all" program is on the rise; plus more health insurance headlines

Physician groups remain split over CMS proposal to allow direct Medicare billing

FierceHealthIT

The Centers for Medicare & Medicaid Services heard both pros and cons on its proposal to allow physicians to bill Medicare patients directly

Heart-Love – Omron’s Holy Grail of Blood Pressure Tracking on the Wrist

Health Populi

It’s February 1st, which marks the first of 28 days of American Heart Month – a time to get real, embrace, learn about, and engage with heart health. Heart disease kills 610,000 people in the U.S. every year, equal to 1 in 4 deaths in America.

Trump targets Medicare, PBMs in plan to lower drug prices

FierceHealthIT

The Trump administration has its sights on major changes to Medicare in its quest for lower drug prices, with proposed changes to Part D formularies and increased scrutiny of PBM rebates

How Walmart Could Bolster Healthcare in the Community

Health Populi

Here’s one description about the chain’s plans to use $200 mm to expand in Florida (THINK: the state will be home to 4,5 million people age 65 and over in 2020, potential candidates for Humana’s Medicare programs. Walmart has been a health/care destination for many years.

Medicare Advantage beats fee-for-service in utilization, outcomes

FierceHealthIT

A new analysis from Avalere shows Medicare Advantage patients have fewer inpatient stays, ER visits and avoidable hospitalizations than fee-for-service beneficiaries, despite higher rates of social and economic risk factors

NEJM study says independent physician ACOs saved Medicare more than hospital-integrated ACOs

FierceHealthIT

While physician group ACOs saved Medicare millions, hospital-integrated ACOs cost the program even more than usual, the Harvard-based researchers found

DOJ investigating Anthem’s Medicare Advantage, Part D plans

FierceHealthIT

The Department of Justice has asked Anthem for more information about its Medicare Advantage and Part D plans as part of an ongoing probe dating back to 2016. Anthem says the inquiry is part of an investigation into other Medicare Advantage health plans, as well as providers and vendors