Tag: Medicare Advantage plans

Possible-Changes-in-Prior-Authorizations

A Surgeon General Touts Possible Changes in Prior Authorizations

Federal healthcare leaders say they are committed to helping physicians, patients, and health insurance companies by improving the prior authorization process for medical care. On Jan. 17, Center for Medicare & Medicaid Services Administrator and U.S. Surgeon General Vice Admiral, held a listening session with health care stakeholders. That was followed by a conference call […]
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what-s-driving-the-transition-to-value-based-care

What’s driving the transition to value-based care?

The COVID-19 pandemic has taught us it’s possible for the health care system to transform care delivery—and quickly. We saw vaccines come to market in record time, heightened cross-industry collaboration to track vaccine statuses, and virtual care use surge. Similarly, the pandemic demonstrated that value-based care delivery models, where payment is based on outcomes versus […]
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aha-asks-cms-to-waive-medicare-advantage-prior-authorization-during-phe

AHA Asks CMS to Waive Medicare Advantage Prior Authorization During PHE

CMS encouraged Medicare Advantage plans to waive prior authorizations during the public health emergency, but AHA urged the agency to make it a requirement instead of a suggestion. The American Hospital Association (AHA) has asked CMS to work with Congress and require Medicare Advantage plans to waive prior authorization processes during the current and future […]
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medicare-advantage-plans-boost-supplemental-benefits-offerings

Medicare Advantage Plans Boost Supplemental Benefits Offerings

Medicare Advantage plans expanded their supplemental benefits offerings in 2022, with more health plans offering special supplemental benefits for the chronically ill (SSBCI), according to an issue brief commissioned by Better Medicare Alliance. Medicare beneficiaries typically join Medicare Advantage plans because of the array of supplemental benefits that the program offers in addition to traditional […]
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cms-releases-medicare-advantage-part-d-proposed-rule-7-changes-to-know

CMS releases Medicare Advantage, Part D proposed rule: 7 changes to know

CMS is proposing a new rule that aims to cut prescription drug costs, increase contract vetting and improve health equity, according to a Jan. 6 news release. The proposed changes primarily target Medicare Advantage and Part D plans. CMS also noted that the proposed changes come with “modest costs” that should not affect bidding, premiums […]
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health-affairs-study-medicare-coverage-denials-more-common-than-medicare-advantage

Study examines differences in coverage denials for traditional Medicare, MA

Traditional Medicare coverage rules make up the bulk of denied services and spending compared to a Medicare Advantage plan, according to a new study in the latest Health Affairs issue. The study, led by the University of Pennsylvania, Harvard University and CVS Health, relied on Medicare Advantage claims that were denied for beneficiaries enrolled with […]
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medicare-advantage-consolidation-drove-healthcare-insurer-trends-2021

Medicare Advantage, consolidation drove healthcare insurer trends in 2021

  COVID-19 continued to affect the industry, which has plowed forward with expanded offerings, digital transformation and other bold moves. It was difficult to predict trend lines for the payer and health insurance industry in 2021, largely because of persistent uncertainties due to the COVID-19 pandemic. Consumer behavior has become more unpredictable, care models and […]
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medicare-advantage-plans-and-the-two-midnight-rule

Medicare Advantage Plans and the Two-Midnight Rule

Medicare Advantage plans hold up their end of the contract with CMS, and provide, at a minimum, a fair reimbursement for services delivered. The physician advisor is a fast-growing specialty that has evolved into so much more than someone who performs endless chart reviews for observation status determinations, medical necessity reviews, peer-to-peer conversations with payors, […]
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