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...
A Medicare Advantage fix: What took so long?
By
James M. Berklan
Apr 12, 2024
Providers hoping that policy makers might some day show some backbone when dealing with Medicare Advantage plans can take heart. Well, at least a little.
Understanding facility, peer data called crucial to better Medicare Advantage negotiations
By
Josh Henreckson
Mar 27, 2024
Nursing homes have historically had little leverage in negotiations with Medicare Advantage plans, even as MA has come to cover an ever-larger number of skilled nursing beneficiaries.
Baseline proficiency for success with managed care payers
By
Susie Mix
Mar 11, 2024
Setting up a building with proficiencies in working with managed care payers is a key to success at this midpoint of the 2020s. Fifty-one percent of Medicare-eligible Americans are covered by Medicare...
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...
Can Medicare Advantage be redeemed?
By
Jean Wendland Porter
Feb 06, 2024
I just got back from vacation and didn’t have to think about this for a whole week. But there’s no place like home. For a whole week, I didn’t have to worry about chores, obligations, or how Medicare...
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.
Lawmakers reignite attacks against ‘scam’ Medicare Advantage plans
By
Jessica R. Towhey
Jul 27, 2023
Federal lawmakers and activists are turning up the heat again on Medicare Advantage, a month after 300 members of Congress told the federal agency that oversees the system to make it easier to manage.