Tag: Medicare Advantage

Value-Based-Care-Plans-improved-health-outcomes-for-MA-members

Medicare Advantage Value-Based Care: Enhanced Health Outcomes

Alongside its positive impact on health outcomes, the Medicare Advantage value-based care plans implemented by an insurance provider resulted in a significant $8 billion in cost savings throughout 2022. Reports from the payer revealed that Medicare Advantage beneficiaries under value-based care exhibited improved health conditions, marked by reduced inpatient admissions and emergency room visits. The […]
Learn More
Benefits-of-ABNs-for-Providers-and-Medicare-beneficiaries

Understanding ABNs for Providers and Medicare Beneficiaries

The Advance Beneficiary Notice (ABN), Form CMS-R-131, issued by the Centers for Medicare & Medicaid Services (CMS), holds immense importance for healthcare providers, revenue cycle teams, and Medicare beneficiaries. What is an ABN (Advance Beneficiary Notice)? An ABN, formally extended to Medicare Fee-for-Service (FFS) beneficiaries, precedes outpatient services like labs, imaging, physical therapy, or observation. […]
Learn More
wide range of Health care bill would impact physicians

Health care bill with a wide range of provisions would impact physicians

The Senate Finance Committee proposed that the full chamber should review a legislation that could instigate alterations in physician practices. This proposition was discussed during a 90-minute meeting on November 8, 2023, regarding the bill named “The Better Mental Health Care, Lower-Cost Drugs, and Extenders Act.” This bill encompasses diverse aspects of healthcare, including mental […]
Learn More
5-tips-you-need-to-know-for-Medicare-Advantage-Plans

Medicare Advantage Plans: What You Need to Know

Uncertain about the details of Medicare Advantage? Here’s what you need to know. The Medicare open enrollment period, running from Oct. 15 to Dec. 7 annually, is now underway. This gives you the chance to make adjustments to your current Medicare coverage. One potential change worth considering is transitioning from original Medicare (Parts A and […]
Learn More
Medicare-advance-plan

Medicare Advantage Plans: A Positive Experience for Beneficiaries

Higher satisfaction with problem resolution was observed among beneficiaries who were more inclined to renew their Medicare Advantage plan. Medicare Advantage plans have garnered favorable satisfaction scores, with beneficiaries showing high approval ratings for trustworthiness, operational ease, and coverage adequacy, as outlined in a recent market research study. The 2023 US Medicare Advantage Study encompasses […]
Learn More
Telehealth Claims

Telehealth Claims Decline in Q1: Things To Know

Based on FAIR Health’s Monthly Telehealth Regional Tracker, the national decline in private insurance telehealth claims reached 5.4% in April, comprising 5.3% of all medical claims. This reduction can be observed across all four U.S. census regions: the Midwest (4.7%), Northeast (6.3%), South (6.8%), and West (6.4%). On average, patient visits lasted between 20 and […]
Learn More
Prior Authorization in Medicare Advantage

Prior Authorization in Medicare Advantage : Lawmakers Call for Streamlined Process

CMS has proposed a rule to simplify prior authorization in government-sponsored health insurance programs. However, some lawmakers are urging the agency to do more. A bipartisan coalition of 233 representatives and 61 senators have written a letter to CMS requesting that the proposed rules be expanded and that the changes be finalized quickly to enhance […]
Learn More
The Impact and Challenges of Medicare Advantage (MA) for Payers and Providers

The Impact and Challenges of Medicare Advantage for Payers and Providers

Medicare Advantage (MA) is becoming more appealing to payers due to its numerous benefits, but providers are struggling to adjust to its effects. Payers are increasingly recognizing the advantages of MA, especially in terms of profitability. According to a study conducted by the Kaiser Family Foundation (KFF), MA insurers disclosed an average gross margin of […]
Learn More
Pushing Back Against Medicare Advantage SNF Denials

Pushing Back Against Medicare Advantage SNF Denials: Part 1

Despite ongoing concerns about denials and beneficiary access to care, Medicare Advantage (MA) companies remain in the spotlight as their market penetration continues to grow. In April 2022, a report from the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) highlighted a significant issue in the capitated payment model employed […]
Learn More
x