Discount drug company Waltz Health moves into Medicare market
Mobi Health News
FEBRUARY 23, 2024
The company will offer a customizable version of its Marketplace Search Technology to health plans supporting Medicare beneficiaries.
Medicare Related Topics 
Medicare Advantage rate cut remains as feds keep up pressure
FierceHealthIT
APRIL 1, 2024
Insurers will feel resentful Monday as the feds opted to not reverse its decision to decrease Medicare Advantage benchmark payments by 0.16%, the Centers for Medicare and Medicaid announced. | CMS is not deviating from its January proposal to modestly rein in Medicare Advantage.
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CMS final rule on broker comp, health equity could shake up Medicare Advantage
FierceHealthIT
APRIL 5, 2024
Centers for Medicare & Medicaid Services finalized a host of actions ranging from broker compensation, health equity, mental health, supplemental benefits and biosimiliars, in the Contract Year | Medicare Advantage plans will need to adjust to new star ratings requirements, industry watchers warned following a final rule on Thursday.
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KFF: A look at healthcare spending trends in Medicare households
FierceHealthIT
MARCH 15, 2024
Medicare households are spending far more on healthcare than other households, according to a new KFF analysis. Medicare households are spending far more on healthcare than other households, according to a new KFF analysis.
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Medicare Is Cutting 2022 FFS Payments 9.75% & Raising CCM Reimbursements by 54%
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Health Insurance in Aisle 3: Why a Grocery Chain is Working on Medicare
Health Populi
AUGUST 3, 2021
“You can trust us to help you find the right Medicare coverage for you and your lifestyle,” the tagline reads. It is, specifically, Midwest Heritage, Hy-Vee’s banking, insurance and investments subsidiary, that will implement the Medicare Aisle program.
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OIG finds $348M in improper Medicare payments for telehealth psychotherapy
Mobi Health News
MAY 8, 2023
According to an audit by the Office of the Inspector General, Medicare improperly paid for $580 million of psychotherapy care, including $348 million of telehealth services, during the first year of the COVID-19 public health emergency.
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CMS seeks input on improving transparency in Medicare Advantage
FierceHealthIT
JANUARY 25, 2024
The Centers for Medicare & Medicaid Services is seeking feedback on how to increase transparency around Medicare Advantage and improve data capabilities. |
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Walgreens to accept Medicare Advantage OTC benefits online
FierceHealthIT
FEBRUARY 28, 2024
Walgreens will now accept a slew of Medicare Advantage supplemental benefits online, including the option for home delivery, the company announced this week. Walgreens will now accept a slew of Medicare Advantage supplemental benefits online, including the option for home delivery, the company announced this week.
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Medicare Advantage beats traditional Medicare in important categories: report
FierceHealthIT
JUNE 28, 2023
Medicare Advantage (MA) beneficiaries have fewer inpatient hospital stays and emergency department visits than beneficiaries in traditional fee-for-service Medicare, according to a
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Chartis: A look at Medicare Advantage enrollment trends in 2024
FierceHealthIT
MARCH 4, 2024
Medicare Advantage (MA) growth has broadly slowed, but the biggest players in this space continue to claim the lion's share of this expansion, according to a new report from healthcare consultant C | Medicare Advantage growth has broadly slowed, but the biggest players in this space continue to claim the lion's share of this expansion, according (..)
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Study: Medicare remote patient monitoring use surges during pandemic
Mobi Health News
AUGUST 11, 2022
Researchers found remote patient monitoring use among Medicare beneficiaries increased from 91 claims per 100,000 enrollees in February 2020 to 594 claims per 100,000 enrollees in September 2021.
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Experts offer Medicare Advantage quality bonus program recommendations
FierceHealthIT
MARCH 5, 2024
A new-look Medicare Advantage (MA) quality bonus program would better incentivize insurers and help individuals choose a more appropriate plan, a report from Urban Institute finds. | A new report looks at how the Medicare Advantage quality bonus program could be improved, including taking the star ratings reporting private.
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Medicare Advantage analysis sparks infighting at MedPAC meeting
FierceHealthIT
JANUARY 12, 2024
A MedPAC meeting on the status of Medicare Advantage held Friday began with numbers on enrollment and insights into coding diagnoses, before devolving into contentious debate over the quality of th | Spirited disagreement arose during MedPAC's Medicare Advantage sessions on Friday, as members debated the merits of the program.
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Payers up against slight decline in 2025 Medicare Advantage payments
FierceHealthIT
JANUARY 31, 2024
Medicare Advantage (MA) payments are set to decrease yet again in 2025 as the feds phase in significant changes to risk adjustment. Medicare Advantage payments are set to decrease yet again in 2025 as the feds phase in significant changes to risk adjustment.
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HHS: Medicare incentives, penalties for hospitals could help stem drug shortages
FierceHealthIT
APRIL 3, 2024
To address the nation’s drug shortages, the Department of Health and Human Services (HHS) is floating a plan that would attach new Medicare payments and penalties to hospitals’ supply chain practic | A white paper penned by HHS outlines a potential program that would push hospitals toward inventory and purchasing practices that reinforce long-term (..)
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Brightside Health expanding Medicare and Medicaid telemental health access
Healthcare IT News - Telehealth
FEBRUARY 22, 2024
Brightside Health will be entering into new and expanded payer partnerships to support telemental healthcare access through Medicare and Medicaid, teaming with companies such as Blue Shield of California, CareOregon and Centene.
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Medicare Advantage marketing practices draw ire from senators
FierceHealthIT
OCTOBER 18, 2023
Seniors are forced to navigate a convoluted Medicare Advantage (MA) landscape for healthcare coverage, often only to be denied care, experts told legislators during a Senate Finance Committee heari | Senators and experts agreed Wednesday that marketing practices from Medicare Advantage plans are often overwhelming for seniors.
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Cigna inks deal to sell Medicare business to HCSC for $3.7B
FierceHealthIT
JANUARY 31, 2024
Cigna will sell off its Medicare business to Health Care Service Corporation in a deal valued at $3.7 HCSC will acquire Cigna's Medicare Advantage, Part D, supplemental benefits and CareAllies businesses, and the parties expect the deal to close in the first quarter of 2025. billion, the company announced Wednesday.
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Cigna explores selling Medicare Advantage business: report
FierceHealthIT
NOVEMBER 6, 2023
Cigna is looking into the possibility of selling its Medicare Advantage (MA) business, according to a report from Reuters. Cigna may decide to sell off its Medicare Advantage business. The insurer is reportedly in early discussions with an investment bank to go over its options.
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HLTH23: Experts debate the flaws, future of Medicare Advantage
FierceHealthIT
OCTOBER 9, 2023
LAS VEGAS—Medicare Advantage (MA) has only grown over the last decade, and, in tandem, voices criticizing the program have gotten louder. | LAS VEGAS—Medicare Advantage has only grown over the last decade, and, in tandem, voices criticizing the program have gotten louder.
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MedPAC report slammed by insurers and docs over Medicare Advantage and physician reimbursement
FierceHealthIT
MARCH 15, 2024
Providers objected to its proposal to give physician reimbursement relief, while plans disagreed with its attitude toward Medicare Advantage. Health plans and providers alike are disgruntled with a new report (PDF) to Congress released | It seems everyone was left unsatisfied by MedPAC's newest report to Congress.
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Moody's: Why Medicare Advantage's profitability may be on the decline
FierceHealthIT
JANUARY 29, 2024
Medicare Advantage (MA) continues to grow, but there are signs that its profitability is on the decline, according to a new report from Moody's Investors Service. Medicare Advantage continues to grow, but there are signs that its profitability is on the decline, according to a new report from Moody's Investors Service.
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Medicare paid out $31.2B in improper payments for FY23, CMS says
FierceHealthIT
NOVEMBER 20, 2023
Traditional Medicare paid out an estimated $31.2 The Centers for Medicare & Medicaid Services released its annual look at improper payments and found that the overall rate in Medicare was 7.38%, which sits below the 10% level mandated in statute.
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Senators working on legislation to reform how Medicare pays physicians
FierceHealthIT
FEBRUARY 9, 2024
A bipartisan group of senators announced Friday that they are working on new legislation for “long-term reforms” to physician payments under Medicare and other program changes. | The lawmakers plan to investigate and pass "long-term reforms" that will "ensure financial stability for providers," among other goals.
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Traditional Medicare lags behind MA, commercial plans in utilization, efficacy: research
FierceHealthIT
SEPTEMBER 20, 2023
Traditional Medicare not only doesn’t measure up to Medicare Advantage (MA) when it comes to cutting back on utilization, it also falls short in many ways compared to commercial insurance for those | Researchers say Medicare Advantage enrollees have more than 50% fewer inpatient hospital stays than FFS Medicare enrollees and 22% fewer visits to emergency (..)
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'A giant unknown': What the alleged $2B Medicare catheter fraud scheme means for ACOs
FierceHealthIT
FEBRUARY 15, 2024
Seven durable medical equipment companies cost the Medicare system $2 billion in payments, the National Association of ACOs (NAACOS) told the federal government in recent months. ACOs could face lasting financial difficulties because of a recent, alleged $2 billion Medicare catheter fraud scheme.
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Waltz Health makes push into Medicare Advantage, inks partnership with SCAN
FierceHealthIT
FEBRUARY 23, 2024
Just a few short months after making a push into the payer space, digital health company Waltz Health is stepping into the Medicare market. Just a few short months after making a push into the payer space, digital health company Waltz Health is stepping into the Medicare market.
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CMS rule to increase Medicare Savings Program enrollment
FierceHealthIT
SEPTEMBER 19, 2023
The Centers for Medicare & Medicaid Services (CMS) finalized a rule Monday to streamline enrollment in Medicare Savings Programs (MSPs) with the aim of making coverage affordable for 860,000 mo | A $26.16 billion CMS rule will streamline Medicare Savings Program enrollment, reducing administrative burden in the process.
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Low-income seniors report deceptive Medicare marketing: study
FierceHealthIT
SEPTEMBER 18, 2023
Seniors are becoming increasingly overburdened by marketing efforts from private Medicare plans, and low-income beneficiaries are twice as likely to file complaints regarding fraudulent phone calls | Fraudulent marketing practices are affecting low-income seniors looking for Medicare plans more than higher-income seniors, a new study has found.
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Accessibility versus flexibility: MedPAC weighs Medicare Advantage standardization
FierceHealthIT
SEPTEMBER 11, 2023
Members of MedPAC, the Medicare Payment Advisory Commission, reiterated their broad support for simplifying the Medicare Advantage (MA) landscape for consumers during a meeting Sept.
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Reduced post-acute care rates could save Medicare billions
FierceHealthIT
OCTOBER 16, 2023
A research brief out of think tank Urban Institute evaluates the prospect of reducing Medicare spending by reining in excessive post-acute care rates. | New research shows that MedPAC's previous proposal for a unified payment structure for post-acute care could save Medicare billions.
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Why Medicare Advantage is lacking on cancer care
FierceHealthIT
NOVEMBER 21, 2023
A City of Hope analysis found that Medicare Advantage members faced a delay of two weeks or more between diagnosis and their first course of therapy.
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Medicare Advantage Lacking In Home Care
Digital Health Wire
MARCH 11, 2024
A study in JAMA Health Forum stirred the pot ahead of a busy HIMSS week by suggesting that Medicare Advantage patients are getting skimped on home care. Researchers conducted a cross-sectional study of 178k traditional Medicare and 107k Medicare Advantage patients, analyzing those who had care between 2019 and 2022.
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Telemedicine, Medicare Advantage and star ratings: What you need to know
Healthcare IT News - Telehealth
JUNE 19, 2023
Over the last few years, Medicare Advantage plans have dramatically increased their deployment of telehealth systems for seniors. While some in the healthcare industry may be skeptical of telehealth’s utilization, particularly within the Medicare population, these plans continue to move full steam ahead.
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Report: HCSC, Elevance Health explore purchase of Cigna's Medicare Advantage business
FierceHealthIT
DECEMBER 15, 2023
While its merger with Humana may have fallen through for now, Cigna is attracting plenty of interest for the rumored sale of its Medicare Advantage business, Bloomberg reported.
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The Challenge for Medicare Part D Patients: Inability to Utilize Pharmaceutical Programs to Reduce Medication Costs
Society for Participatory Medicine
MARCH 29, 2024
A sample Medicare Part D illustration from Senior-Advisors.com. Introduction In the United States, Medicare Part D provides prescription drug coverage for millions of seniors and individuals with disabilities. See sample illustration, year 2020, from Medicare advisor site Senior-Advisors.com.] Let us know in the comments.
DOJ charges former HealthSun executive for role in Medicare fraud scheme
FierceHealthIT
OCTOBER 27, 2023
The Department of Justice (DOJ) has filed charges against a former HealthSun Health Plans executive as part of an alleged multimillion-dollar Medicare fraud scheme. | The Department of Justice has filed charges against a former HealthSun Health Plans executive as part of an alleged multimillion-dollar Medicare fraud scheme.
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Medicare Advantage, RPM & Star Ratings: Elevate Plan Performance by Impacting SDoH
Clear Arch Health
JANUARY 10, 2024
Providing value-based, member-centric care t o address Social Determinants of Health (SDoH) - via remote health monitoring services - can mitigate adverse impact to patients, and may help to ensure Medicare Advantage plan success. Ready to take your Medicare Advantage plan to the next level?
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Medicare 101 for Digital Health Part 1: What is Medicare and how did it get this way?
Mobi Health News
NOVEMBER 24, 2020
An Intro to Medicare - and how Digital Health companies can impact the nation’s biggest payer.
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Medicare Advantage fraud in DOJ's crosshairs after agency reports $2.7 billion in settlements
FierceHealthIT
FEBRUARY 23, 2024
The agency said it is still litigating Medicare Advantage cases against major insurers. Under the False Claims Act, more than $1.8 billion last year, according to the Department of Justice.
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UnitedHealthcare hit with class action over alleged use of AI to deny Medicare Advantage claims
FierceHealthIT
NOVEMBER 15, 2023
UnitedHealthcare is facing a potential class action lawsuit following allegations that it used an algorithm to deny claims for post-acute care services in Medicare Advantage.
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Huge decline in spending on Medicare begs the question: Why?
FierceHealthIT
SEPTEMBER 6, 2023
Research shows that Medicare spending has leveled off for the past decade, morphing from something that experts worried might break the federal budget to an unexpected bright spot. Medicare had once been seen as something that would one day break the budget. However, Medicare spending in the last decade slowed greatly.
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What Do Medicare Parts A, B, C, D Mean?
Electronic Health Reporter
APRIL 27, 2023
Medicare is a federal health insurance program in the United States that provides coverage to people 65 or older and some younger people with specific disabilities. The program is divided into several parts, covering different […] The article What Do Medicare Parts A, B, C, D Mean? Illegal copying is prohibited.
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