Tagged with Medicare Advantage
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.
New research from several studies indicate traditional Medicare spending growth is slowing as Medicare Advantage (MA) enrollment grows.
As of October 1, the year-long grace period for ICD-10 claims submissions has ended. To assist coders and hospitals, CMS has revised its Q&A “Questions and Answers Related to the July 6, 2015, CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities.”
Despite debates over Medicare Advantage (MA) costs and benefits vs. traditional Medicare, MA continues to expand. It continues to be attractive for insurers and is increasingly attractive to provider-sponsored plans. MA is expected to exceed 40% of Medicare within a few years.
Effective September 19, Humana will update claim processing edits for Surgery procedures, including: sigmoidoscopy, colonoscopy, other medical and surgical service during the postoperative period, FL Medicaid services included in delivery, birth center non-covered services, Florida Medicaid, and extracorporeal photopheresis.
Effective September 19, Humana will update claim processing edits for Internal Medicine procedures, including: Sequential IV push, Telephone assessment and management, Home visit, Polysomnography, and Immune globulin.
Effective November 1, for participating providers and August 1, for non-participating providers, UnitedHealthcare will require CLIA Number on Laboratory Claims submitted on a CMS 1500 form or HIPAA 5010 837 P file.