Healthcare Dive

FEBRUARY 7, 2024

The insurer on Wednesday joined its peers in slamming proposed MA payment rates as insufficient given the dogged increase in medical costs.

Medicare 266

Medicare Medicare 266

Fierce Healthcare

SEPTEMBER 26, 2023

Expect premiums, benefits and plan choices for Medicare Advantage (MA) and the Medicare Part D prescription drug program to look similar in 2024, the Centers for Medicare & Medicaid Services (C | CMS announced that nearly three-quarters of MA plan beneficiaries will not see their premiums rise.

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Medicare Medicare Medicaid Medicaid 117

Healthcare Dive

FEBRUARY 20, 2024

The big question coming out of the health insurance earnings season is how much elevated utilization among seniors will carry over into 2024.

Medicare 305

Medicare Medicare Health Insurance 305

Fierce Healthcare

MARCH 4, 2024

Medicare Advantage (MA) growth has broadly slowed, but the biggest players in this space continue to claim the lion's share of this expansion, according to a new report from healthcare consultant C | Medicare Advantage growth has broadly slowed, but the biggest players in this space continue to claim the lion's share of this expansion, according (..)

Medicare 120

Medicare Medicare 120

Healthcare Dive

JANUARY 8, 2024

The payer is taking issue with how regulators calculated quality scores for 2024, after seeing a stars decline that could cause its bonus revenue to fall by $500 million.

Medicare 288

Medicare Medicare 288

Med Law Blog

NOVEMBER 6, 2023

CMS issued the Final Rule for the 2024 Medicare Physician Fee Schedule (PFS) on November 2, 2023, for payments to be effective on or after January 1, 2024. Fee Schedule Link The overall payment rates under the PFS will be reduced by 1.25% in calendar year 2024.

Medicare 52

Medicare Medicare 52

HealthIT Answers

MARCH 11, 2024

RISE National: Downtown Nashville, March 17-19, 2024. The trusted source for all things Medicare Advantage, crossing a variety of topics and themes from risk adjustment and quality to member experience and social determinants of health. The post RISE National 2024 appeared first on Health IT Answers.

Medicare 64

Medicare Medicare 64

Modern Healthcare

JULY 31, 2023

Skilled nursing faciltiies will receive a higher Medicare pay bump in fiscal 2024 than proposed by the Centers for Medicare and Medicaid Services in April.

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Nursing Homes Medicare Medicare Nurses 80

Med Law Blog

JULY 17, 2023

The 2024 Medicare Physician Fee Schedule proposes a 3.34% decrease in the 2024 PFS conversion factor. It’s currently $33.89 and is proposed to be reduced to $32.75.

Medicare 52

Medicare Medicare 52

Fierce Healthcare

MARCH 31, 2023

CMS to raise Medicare Advantage pay rates by 3.3% in 2024; phase in risk adjustment changes rking Fri, 03/31/2023 - 16:02

Medicare 135

Medicare Medicare 135

Innovaare Compliance

DECEMBER 11, 2023

Before the Medicare Advantage Open Enrollment Period (MA OEP) [1] begins on January 1, 2024, Medicare Advantage Organizations (MAOs) still have time to review if they are completely ready for a new contract year. This blog article focuses on some of the “must make” changes to take effect as of January 1, 2024, or before.

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Medicare Medicare Compliance Medicaid 52

HealthIT Answers

APRIL 8, 2024

By Beth Friedman - RISE National 2024: Regardless of the speaker, track, or motivation, the overarching theme of all discussions was trust. Trust is vital for problem-solving in healthcare especially true for the Medicare Advantage program.

Medicare 59

Medicare Medicare 59

HealthIT Answers

AUGUST 12, 2023

On August 1, 2023, the CMS issued the fiscal year 2024 Medicare hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) final rule. The final rule updates Medicare fee-for-service payment rates and policies for inpatient hospitals and LTCHs for FY 2024.

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Medicare Medicare Hospitals Payment Systems 52

Compliancy Group

APRIL 17, 2024

Office of Inspector General (OIG) in the Department of Health and Human Services (DHHS) oversees efforts in the healthcare sector to identify, reduce, and prevent incidents of fraud, waste, and abuse of funds from programs like Medicare. Medicare Advantage (M.A.): and cybersecurity threats. Organizations using M.A.

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Compliance Officers Compliance Medicare Medicare 52

Healthcare Dive

APRIL 18, 2024

The findings suggest it would be challenging to restrict telehealth payment in Medicare, researchers said. Some pandemic flexibilities are set to expire at the end of 2024.

Medicare 144

Medicare Medicare 144

Innovaare Compliance

OCTOBER 31, 2023

2024 Star Ratings , which CMS released on Oct 13 th , 2023, has forced the industry to deeply introspect and re-strategize the path forward with newer evaluation dynamics at play. More membership was distributed across lower Star ratings in 2024 compared to 2023. ” (replace life with Star ratings!)

Medicare 52

Medicare Medicare Compliance 52

Healthcare Dive

JANUARY 31, 2024

The payer is leveraging CenterWell’s growing network of primary care centers for seniors to boost margins in its hard-pressed Medicare Advantage business.

Medicare 144

Medicare Medicare 144

Fierce Healthcare

FEBRUARY 1, 2023

CMS proposes small hike to Medicare Advantage, Part D plan payments in 2024 amid risk adjustment changes rking Wed, 02/01/2023 - 17:35

Medicare 109

Medicare Medicare 109

Fierce Healthcare

JANUARY 8, 2024

For the 2023 plan year, Aetna's performance in the annual Medicare Advantage star ratings took a massive hit, with just 21% of its members enrolled in plans that earned a score of four stars or mor | After a rough showing a year ago, Aetna bounced back for 2024, and was one of the stronger performers in the latest star ratings.

Medicare 113

Medicare Medicare 113

Fierce Healthcare

OCTOBER 2, 2023

Independence Blue Cross unveiled Medicare Advantage (MA) packages that the company said will greatly enhance benefits for its MA members, including a bigger allowance for vision, dental, hearing an | The MA enhancements touted by Independence Blue Cross include reducing premiums for its Personal Choice 65 PPO while including a Part B giveback and a (..)

Medicare 109

Medicare Medicare 109

Hall Render

DECEMBER 12, 2023

On November 16, 2023, the Centers for Medicare & Medicaid Services (“CMS”) published proposed changes to the Medicare provider enrollment requirements in the Calendar Year 2024 Physician Fee Schedule final rule (“Final Rule”).

Medicare 40

Medicare Medicare Licensing Malpractice 40

Fierce Healthcare

JANUARY 12, 2023

MedPAC calls for slight pay update to 2024 Medicare rates for hospitals, physicians. Thu, 01/12/2023 - 14:33.

Medicare 98

Medicare Medicare Hospitals 98

Fierce Healthcare

SEPTEMBER 29, 2023

The industry is just two weeks away from the beginning of Medicare's annual enrollment period, a critical window for the hottest market in insurance. | The industry is just two weeks away from the beginning of Medicare's annual enrollment period, a critical window for the hottest market in insurance.

Medicare 120

Medicare Medicare 120

HealthIT Answers

FEBRUARY 5, 2024

CMS announced increased participation in CMS’ accountable care organization initiatives in 2024, which will increase the quality of care for more people with Medicare. Of note, CMS is announcing that 19 newly formed ACOs in the Medicare Shared Savings Program are participating in new, permanent payment option beginning in 2024.

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Medicare Medicare 59

Medisys Compliance

APRIL 11, 2024

A New Era for Mental Health Access The landscape of mental healthcare in the United States underwent a significant change on January 1, 2024. Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) can now directly bill Medicare for services they furnish and diagnose.

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Medicare Medicare Medical Billing Outsourcing Medical Billing 59

Fierce Healthcare

DECEMBER 18, 2023

Payers need to properly adapt to changes made to the Medicare Advantage star ratings program or risk financial repercussions, industry experts told Fierce Healthcare. Payers are being urged to prioritize health equity considerations more than ever before to improve their Medicare Advantage star ratings scores.

Medicare 117

Medicare Medicare 117

Healthcare Law Blog

AUGUST 11, 2023

On July 13, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued its proposed rule (the “Proposed Rule”) for the 2024 Medicare Physician Fee Schedule (“PFS”). CMS projects that the Proposed Rule will lead to growth in the Medicare Shared Savings Program (“MSSP”).

Medicare 52

Medicare Medicare Nurses Medicaid 52

Hall Render

NOVEMBER 29, 2023

On November 2, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued the 2024 Medicare Physician Fee Schedule Final Rule (“Final Rule”) for calendar year (“CY”) 2024. These changes become effective on January 1, 2024.

Medicare 40

Medicare Medicare Nurses Payment Systems 40

MedTrainer

JANUARY 10, 2024

It’s that time of the year to check your records for 2023 compliance deficiencies and set your organization up for success in 2024. Release of Industry-Specific Compliance Program Guidance (ICPG) is anticipated in 2024. It may seem a little early to do some spring cleaning, but not when it comes to compliance!

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Compliance Fraud HIPAA Compliance Officers 94

The Health Law Firm Blog

APRIL 15, 2024

Board Certified by The Florida Bar in Health Law On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. By: George F. Indest III, J.D., The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts.

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Fraud Medicare Medicare Telemedicine 52

HealthIT Answers

FEBRUARY 29, 2024

By Shanta Lewis - New regulations, rolled out by CMS as part of the 2024 Medicare Physician Fee Schedule (MPFS) final rule, took effect on January 1, 2024, and finalized CMS’s definition of the “substantive portion” of a split/shared visit, first introduced in 2022.

Medicare 59

Medicare Medicare 59

Verisys

APRIL 2, 2024

March 2024 Bad Actor Roundup By Verisys Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Million Medicare Fraud Scheme ( Full Story ) New York-Presbyterian/Brooklyn Methodist Hospital Settles Health Care Fraud Claims for $17.3 The post March 2024 Bad Actors Roundup appeared first on Verisys.

Fraud 52

Fraud Telemedicine Licensing Doctors 52

Verisys

MARCH 8, 2024

February 2024 Bad Actor Roundup By Verisys Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Million Medicare and Medicaid Fraud Full Story Pharmacist Fraud Pharmacy Owner and Operations Manager Convicted of $2.3M The post February 2024 Bad Actors Roundup appeared first on Verisys.

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Fraud Medicaid Medicaid Medicare 52

Healthcare Dive

DECEMBER 22, 2023

A shift in funding sources, new regulatory policies in Medicare and technology advances may influence M&A in the sector next year, according to Samantha Prokop from law firm Gunster, Yoakley & Stewart.

Medicare 205

Medicare Medicare 205

Innovaare Compliance

DECEMBER 25, 2023

Summary of the HPMS Memo Generated by USHER (Inovaare’s AI-powered Compliance Assistant) The Centers for Medicare and Medicaid Services (CMS) issued a memorandum detailing several announcements relating to its 2024 CMS program audit. Prepare for both routine and focused audits to be conducted in 2024 by CMS.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Health Care Law Brief

APRIL 3, 2023

On Friday, March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ( Rate Announcement ). 1395w-23): Medicare Advantage Organizations (MAOs) are paid a base rate by CMS. Risk Adjustment.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Innovaare Compliance

FEBRUARY 25, 2024

The Centers for Medicare & Medicaid Services (CMS) uses the Hierarchical Condition Category (CMS-HCC) medicare risk adjustment model to determine monthly capitation fees for Medicare Advantage (MA) plans. June 3, 2024, is the deadline for submitting bids for Parts C and D. PDT on June 3, 2024.

Medicare 52

Medicare Medicare Medicaid Medicaid 52