Tag: Medicare Advantage

5-steps-employers-can-take-to-implement-advanced-primary-care

Steps Employers Can Take To Implement Advanced Primary Care

Advanced primary care can help employers control costs and coordinate care, but many employers do not know how to start and scale such a solution in their employer-sponsored health plans, according to a report from the Duke-Margolis Center. Primary care is an essential part of preventing high-cost health conditions among employees. However, only slightly more […]
Learn More
prime-healthcare-hospitals-new-jersey-cut-ties-unitedhealthcare-citing-low-reimbursement

Prime Healthcare hospitals cut ties with UnitedHealthcare, citing low reimbursement

Prime’s New Jersey hospitals will continue to honor the rates and services in the agreements until the end of the cooling off period. The decision impacts Saint Clare’s Health in Denville, Dover and Boonton, Saint Michael’s Medical Center in Newark, and Saint Mary’s General Hospital in Passaic. Dr. Sonia Mehta, regional CEO and chief medical […]
Learn More
Medicare Reimbursement Rates for COVID-19

CMS Sets Medicare Reimbursement Rate for COVID-19 Vaccine

A new interim final rule with comment period ensures Medicare reimbursement for the administration of a COVID-19 vaccine and provider use of innovative treatments for the novel coronavirus. The rule released last night states that Medicare will pay providers $28.39 for the administration of a single-dose COVID-19 vaccine. In the event an approved COVID-19 vaccine requires multiple […]
Learn More
Home Dialysis Medicare Payment

CMS Finalizes Payment Model Aimed At Boosting Access to Home Dialysis, Kidney Transplants

The Trump administration has finalized a rule aimed at boosting access to home dialysis and translation for patients with end-stage renal disease. The Centers for Medicare & Medicaid Services estimates that the End-Stage Renal Disease Treatment Choices Model will save Medicare $23 million over the next five years. The value-based model is designed to incentivize providers to […]
Learn More
Medicare Advantage Overpayments

CMS Goes After Medicare Advantage Overpayments

The Centers for Medicare & Medicaid Services (CMS) knows that a significant amount of money is being overpaid to insurance companies in the Medicare Advantage program, but they have yet to recover these overpayments. That’s about to change. CMS says it will increase the audits being performed on Medicare Advantage risk-adjusted code submissions and apply […]
Learn More
Medicare Advantage

Medicare Advantage And The Future Of Value-Based Care

The Medicare Advantage (MA) program, which allows Medicare beneficiaries to voluntarily enroll in a private plan that administers health benefits, was established by the Balanced Budget Act (BBA) of 1997 as a vehicle to bring private-sector competition and innovation to Medicare beneficiaries. When the program was announced, the goal was to create greater competition on […]
Learn More
Medicare Advantage Plan

Medicare Advantage Plan Denials: Is That Convoluted or What?

Medicare Advantage Plan contracts are “take-it-or-leave-it” agreements Many questions are swirling about regarding Medicare Advantage Plan (MAP) denials asking what to do about the increasing number and given reasons.  I’ve heard or read some amazing stories where payers have gone to astounding lengths to deny claims.  Answers are also swirling about based on understandings of […]
Learn More
x