Tagged with Medicare Advantage
The Senate Finance Committee unanimously passed the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017. The legislation seeks to expand telehealth services to Medicaid populations and has received a favorable score by the Congressional Budget Office.
Harvard Pilgrim is updating commercial and StrideSM (HMO) Medicare Advantage medical review criteria for the medication infliximab (Remicade/Inflectra) to allow coverage for the CPT code.
The CHRONIC Care Act of 2017 was reintroduced to Congress this month. The proposed bill targets Medicare payment reform for chronic disease management services and would promote the use of telehealth by eliminating geographic restrictions on telestroke consult services, expand telehealth coverage under MA part B, and give ACOs more flexibility to use telehealth services.
United Healthcare reported first-quarter revenues of $48.7 billion – a 9.4% year-over-year increase from last year. The insurer says that due to 3% insurance tax in Affordable Care Act, plan premiums will likely rise in 2018.
CMS has released 2018 Medicare Advantage and Part D payment rates, announcing a 0.45% average rate increase. According to CMS, the changes made aim at providing benefit flexibility and efficiency which will allow Medicare enrollees to choose the care that best fits their health needs.
The U.S. Justice Department recently disclosed that there will be an investigation into four more major health insurers as part of a False Claims Act lawsuit filed against UnitedHealth Group in 2011.
The long-anticipated legislation to repeal and replace the ACA’s core features was unveiled on March 6.
The DOJ moves forward with legal action against two insurers accused of erroneous coding and inflated billing – UnitedHealth and WellMed Medical Management.
Humana has announced its plans to cease sales of individual health insurance plans through the ACA’s exchanges by 2018, potentially leaving more than 150,000 customers without a carrier.
In effort to reduce the significant Medicare appeals backlog, CMS finalized regulations for the Medicare Program: Changes to the Medicare Claims and Entitlement, Medicare Advantage Organization Determination, and Medicare Prescription Drug Coverage Determination Appeals Procedures. According to HHS, the final rule streamlines administrative appeal processes, increases consistency in decision making across appeal levels, and improves efficiency for both appellants and adjudicators.
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) has issued a final rule expanding the authority to exclude individuals and entities from federal health care programs.
CMS has announced proposed changes to the Part D prescription drug program and Medicare Advantage for calendar year 2018.
The Medicare Payment Advisory Commission (MedPAC) has approved recommendations calling for health care provider payment increases in FY2018.
Blue Cross and Blue Shield of Western New York (BCBSWNY) says their 2017 plans will offer stable rates and a range of options for seniors, as well as support needed to make the most educated decision.
Aetna will soon offer two Medicare Advantage Part D/Prescription Drug (MAPD) plans in three counties in Central Florida.
WellCare Health Plans of Florida is embracing technology with its new in-home telemonitoring program for Medicare Advantage members with chronic conditions in Arkansas, Mississippi and Tennessee.
Eleven private insurers have joined forces in seeking action from the Congressional Budget Office (CBO) to expand data collection when scoring congressional proposals to include telemedicine data from non-Medicare sources as a means to support value-based care efforts.
CMS has announced a temporary freeze on new proposals from health insurance companies pursuing automatic enrollment of commercial or Medicaid patients into Medicare Advantage plans.
Humana, UnitedHealthcare, WellCare, Blue Cross and Blue Shield of Florida and CVS Health are among those participating in a Medicare Part D model that gives insurers financial incentives to offer innovative programs that encourage patients to take their medications.
Indiana University Health Plans has announced it will not offer plans on the state’s Affordable Care Act marketplace in 2017.