CMS finalizes long-awaited prior authorization rule for Medicare Advantage
By
Josh Henreckson
Jan 18, 2024
A new rule on Medicare Advantage prior authorization finalized by the Centers for Medicare & Medicaid Services Wednesday suggests good news for providers and Medicare recipients.
CMS pledges to use ‘full array’ of tools to enforce 2024 Medicare Advantage rules
By
Josh Henreckson
Jan 12, 2024
Despite early fears, long-term care leaders have some reason to be optimistic that changes to Medicare Advantage rules for 2024 will be enforced.
Long-term care leaders cheer proposed Medicare Advantage appeals rule in final push
By
Josh Henreckson
Jan 08, 2024
A surge of public and professional support arrived Friday as the comment period closed for a proposed federal rule that providers say could level the playing field with Medicare Advantage plans.
Medicare Advantage plans intent on skirting new rules, providers fear
By
Kimberly Marselas
Dec 01, 2023
Aging services providers are increasingly concerned that powerful Medicare Advantage plans will not fall into line under new federal rules, which were once seen as the possible beginning of a tide change...
Medicare Advantage: A not-so-advantageous deal for beneficiaries and providers
By
Brendan Williams
Nov 29, 2023
Open enrollment is well underway for Medicare, as television viewers inundated with cheesy insurance company ads can tell. Those ads must work. For the first time 2024 will see most Medicare...
Amid cacophony of action, some happy noise on Medicare Advantage
By
Kimberly Marselas
Nov 08, 2023
CHICAGO — I was drawn into the provider payment conversation early and often at the LeadingAge conference here this week, but the tone wasn’t quite what I expected. After years of dark messaging on...
CMS proposal offers long-awaited fix for Medicare Advantage appeals
By
Kimberly Marselas
Nov 08, 2023
Skilled nursing providers would get a new, improved appeals process for Medicare Advantage denials under a proposal issued late Monday by the Centers for Medicare & Medicaid Services.
Fogg clears the air on skilled nursing ‘tailwinds’
By
James M. Berklan
Oct 26, 2023
The headwinds for skilled nursing operators are significantly more numerous than the potential tailwinds, but there are reasons for provider optimism.
Another week, more Medicare dis-Advantages
By
Kimberly Marselas
Aug 22, 2023
It’s starting to feel like every week brings another reason to begrudge Medicare Advantage plans their market-dominating growth.
Medicare Advantage plan settles upcoding allegations for $22.5M
By
Kimberly Marselas
Aug 02, 2023
A Medicare Advantage plan will pay $22.5 million to settle allegations that it systematically reviewed patient charts to tack on additional charges before submitting claims to Medicare, federal law enforcement...