How often do health insurers say no to patients? No one knows.
By
Robin Fields/ProPublica
Jun 29, 2023
It’s one of the most crucial questions people have when deciding which health plan to choose: If my doctor orders a test or treatment, will my insurer refuse to pay for it?
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.
‘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.
Nursing homes have to fight for pay protections in Medicare Advantage rule: expert
By
Kimberly Marselas
Apr 27, 2023
Providers must play an active role in stopping aggressive Medicare Advantage practices that have for years limited access to skilled nursing care, a top managed care expert warned administrators gathered...
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,...
CMS completes minimum staffing study; targeting ‘onerous’ MA authorizations
By
Kimberly Marselas
Jan 25, 2023
Two proposed rules should help patients improve their Medicare Advantage plan selections while standardizing expectations for skilled nursing and other healthcare providers, federal officials reiterated...
Medicare Advantage enrollees get less post-acute care than traditional beneficiaries: analysis
By
Joe Bush
Sep 19, 2022
Members of Medicare Advantage plans used post-acute care less than people with traditional Medicare, according to an analysis of 62 studies.
‘Death spiral’ for SNFs as Medicare Advantage pay decreases
By
Kimberly Marselas
Sep 06, 2022
Pressure to accept low-ball contracts with Medicare Advantage plans that continue to reduce reimbursement is driving some skilled nursing providers into “a death spiral,” a major aging services association...
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.
Providers warned not to interfere with resident healthcare coverage choices after $8 million settlement
By
Danielle Brown
Jul 13, 2022
The nation’s largest nursing home association is urging providers to properly educate staff on acceptable practices when it comes to discussing changes to residents’ healthcare coverage in order to...