Tagged with Medicare Advantage
Harvard Pilgrim: Infliximab Medical Review Criteria Update
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.
Congress to Revisit Telehealth for Chronic Care Legislation
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.
Unitedhealth Posts Strong Earnings Growth in First Quarter
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 2018 MA, Part D Final Payment Rates Announced with 0.45% Increase
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.
Justice Department Discloses False Claims Act Investigation into Multiple Payers
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.
Affordable Care Act Repeal Proposal Unveiled
The long-anticipated legislation to repeal and replace the ACA’s core features was unveiled on March 6.
DOJ v. UnitedHealth
The DOJ moves forward with legal action against two insurers accused of erroneous coding and inflated billing – UnitedHealth and WellMed Medical Management.
Humana to Exit ACA Exchanges by 2018
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.
CMS Finalizes New Rule to Reduce Medicare Appeals Backlog
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.
OIG Final Rule Expands Exclusion Authorities
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 Proposes 0.25% Medicare Advantage Rate Increase
CMS has announced proposed changes to the Part D prescription drug program and Medicare Advantage for calendar year 2018.
MedPac Approves Pay Increase Recommendations for Hospitals, Physicians
The Medicare Payment Advisory Commission (MedPAC) has approved recommendations calling for health care provider payment increases in FY2018.
