Lawmakers say CMS should ban Medicare Advantage’s use of AI to deny care
By
Josh Henreckson
Jun 26, 2024
The Centers for Medicare & Medicaid Services should consider banning artificial intelligence from being used to deny Medicare Advantage coverage pending a “systematic review,” a group of 49 congressional...
Providers express support for MA prior authorization reform bill
By
Donna Shryer
Jun 16, 2024
Nursing home and senior living providers on Friday praised the newly introduced Improving Seniors’ Timely Access to Care Act, which would address the longstanding issue of prior authorization required...
Sector, consumer advocates vent shared frustrations on Medicare Advantage lack of transparency to CMS
By
Josh Henreckson
Jun 02, 2024
Long-term care leaders and consumer advocates — often at odds over nursing home policy — have voiced their shared frustrations about Medicare Advantage plans to the Centers for Medicare & Medicaid...
CMS official to providers: Help us capture data to drive Medicare Advantage reforms
By
James M. Berklan
Mar 07, 2024
The increased use of health data and providers’ own voices should be considered among the best tools available for achieving change in a system that increasingly relies on Medicaid Advantage and other...
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.
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.
Class action suit targets Medicare Advantage insurer’s use of AI to end rehab stays
By
Josh Henreckson
Dec 14, 2023
Two skilled nursing patients filed a class action suit against Humana Tuesday — alleging their Medicare Advantage benefits were cut prematurely short because of Humana’s wrongful reliance on artificial...
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...