MA enrollees receive less intensive end-of-life care, study finds
By
Donna Shryer
Jul 21, 2024
A new study published in JAMA Health Forum reports that Medicare Advantage (MA) enrollees receive less intensive end-of-life care compared to those in traditional Medicare (TM). To identify this conclusion,...
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 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.
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?
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.
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...
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.