Medicare Advantage retaining sicker patients with more complex health needs: study
By
Alicia Lasek
Jun 29, 2023
After years of criticism for cherry-picking healthier people for enrollment, Medicare Advantage is now holding onto more patients with chronic conditions, investigators say.
Lawmakers pushing CMS to ease Medicare Advantage prior authorizations
By
Kimberly Marselas
Jun 26, 2023
Close to 300 members of Congress are urging federal regulators to do more to reduce burdensome Medicare Advantage requirements that can slow delivery of care to nursing home and other patients.
MA plans pocket billions more by enrolling less-costly patients
By
Kimberly Marselas
Jun 16, 2023
Medicare Advantage plans may be receiving overpayments of as much as 20%, finds a new study published by a health and aging think tank.
‘Impossible’ Medicare Advantage denials decried during Senate hearing
By
Kimberly Marselas
May 18, 2023
A Senate subcommittee Wednesday sent letters to the nation’s largest Medicare Advantage insurers, demanding they reveal internal documents that illustrate how they make coverage determinations.
Clinical briefs for Tuesday, March 21
By
Alicia Lasek
Mar 20, 2023
LeadingAge: MA program failures jeopardize health of nearly 30 million older adults … Behavioral health is crucial ingredient in new Michigan home care program … Patients prefer to see test results...
As CMS tightens vise on Medicare Advantage, providers argue for even more help
By
Kimberly Marselas
Feb 15, 2023
Forty-five days after proposing changes that attempt to rein in some of the most-criticized practices of Medicare Advantage plans, federal officials now must filter through nearly 1,000 formal comments.
Flurry of Medicare Advantage regulation likely to hit nursing home coffers
By
Kimberly Marselas
Feb 03, 2023
Federal efforts to rein in Medicare Advantage spending and recoup payments awarded for improper diagnoses will likely lead to even more financial pressure on nursing homes that serve plan beneficiaries,...
House committee approves bill that would reform prior authorization under Medicare Advantage program
By
Danielle Brown
Jul 29, 2022
Providers demanding change to the Medicare Advantage program may soon get their wish after a House panel advanced a measure that would reform the program’s prior authorization process.
MA enrollees with dementia report poor quality of care: study
By
Alicia Lasek (f3)
May 09, 2022
Medicare Advantage plans will be more incentivized to address gaps in care if consumer care assessments include more input from enrollees with dementia, investigators say.
Providers demand fixes after feds find MA plans wrongly delay or deny SNF services too often
By
Danielle Brown
May 02, 2022
Skilled nursing providers are demanding changes after a new federal report found that Medicare Advantage organizations (MAOs) have improperly denied or delayed services to beneficiaries to increase profits.