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Fixing Medicare Advantage Payments

Healthcare IT Today

There’s widespread consensus that payments to Medicare Advantage Organizations (MAOs) are a mess. Here, we adopt a position sympathetic to the hurdles facing Medicare Advantage plans and look at how they are trying to improve the quality of data.

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Biden’s plan to improve Medicare solvency targets prescription drugs

Healthcare Dive

The plan — part of Biden’s 2024 budget proposal set to be released Thursday — would further reduce what Medicare pays for prescription drugs and raise taxes on Americans earning over $400,000

Medicare 278
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Medicare to collect drug price rebates starting in 2025

Healthcare Dive

The CMS has laid out how it plans to implement a key provision of the Inflation Reduction Act requiring drugmakers to pay rebates on price hikes in Medicare that are greater than inflation

Medicare 273
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Government watchdog warns of Medicare fraud after relaxing provider requirements

Healthcare Dive

The Government Accountability Office is urging the CMS to resume certain eligibility checks on providers whom they consider at high risk of fraud to the Medicare program

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Seniors to see reduced delays in Medicare coverage under new Biden admin policies

Healthcare Dive

Under the changes, traditional Medicare coverage will kick in the month immediately after enrolling

Medicare 278
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Insurance lobby blasts Medicare Advantage audit rule

Healthcare Dive

America’s Health Insurance Plans lobby said the rule seeking to claw back billions of dollars from health insurers is unlawful and fatally flawed

Medicare 237
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OIG report suggests telehealth fraud rare in Medicare

Healthcare Dive

A small proportion of providers that billed for telehealth — 1,714 out of 742,000 — posed a high risk of fraud or abuse to Medicare in COVID-19’s first year, regulators found

Fraud 253
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How To Market to Medicare Patients

Electronic Health Reporter

The article How To Market to Medicare Patients appeared first on electronichealthreporter.com. Editorial How To Market to Medicare Patients Ways to Market to Medicare PatientsThis article is copyrighted strictly for Electronic Health Reporter. Illegal copying is prohibited. Nowadays our lives are engulfed with advertisements from gigantic billboards on the streets to our TVs to pop-ups online. That saturation can make useful information hard to find.

Medicare 133
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Omnibus bill restarts Medicaid checks, lowers Medicare physician pay cuts

Healthcare Dive

Lawmakers are rushing to speed passage of the $1.7 trillion omnibus spending package as they near a Friday deadline for government funding

Medicaid 316
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Staying Clear of the Medicare Exclusion List

Compliancy Group

are missing out on most of these opportunities because their names are on the HHS OIG (Health and Human Services, Office of Inspector General) Medicare Exclusion List. Believe it or not, there are those who don’t know they are on the Medicare Exclusion List.

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Congress finally eliminates Part D vaccine cost sharing: Medicare coverage is still broken

Healthcare Dive

The Inflation Reduction Act leaves intact a peculiar split in Medicare vaccine coverage that discourages physicians from offering certain vaccines, argues former Moderna Vice President Richard Hughes

Medicare 291
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CMS redesigns controversial Medicare direct contracting model

Healthcare Dive

The decision to retain the direct contracting model — albeit with numerous changes and a new name — was met with mixed reactions from stakeholders

Medicare 307
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How Modern Technology Revolutionizes Medicare Buying Process

Electronic Health Reporter

The article How Modern Technology Revolutionizes Medicare Buying Process appeared first on electronichealthreporter.com. Editorial buying Medicare Medicare buyingThis article is copyrighted strictly for Electronic Health Reporter. Illegal copying is prohibited.

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Government Watchdogs Attack Medicare Advantage for Denying Care and Overcharging

Kaiser Health News

Congress should crack down on Medicare Advantage health plans for seniors that sometimes deny patients vital medical care while overcharging the government billions of dollars every year, government watchdogs told a House panel Tuesday. Bliss said Medicare paid $2.6

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Medicare’s Open Enrollment Is Open Season for Scammers

Kaiser Health News

Finding the best private Medicare drug or medical insurance plan among dozens of choices is tough enough without throwing misleading sales tactics into the mix. The problems are especially prevalent during Medicare’s open-enrollment period, which began Oct.

Medicare 145
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CMS rule aimed at improving Medicare Advantage draws praise

Healthcare Dive

Proposed changes target prior authorization holdups and misleading advertising while aiming to expand access to behavioral health care and affordable prescriptions

Medicare 260
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Hospitals charge employer health plans more than 2 times what they charge Medicare for same services

Healthcare Dive

Florida, West Virginia and South Carolina had relative prices at or above 310% of Medicare prices, according to the report Rand researchers also found wide price variations across states.

Medicare 299
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Supreme Court Rules Against HHS in Hospital Medicare Reimbursement Case

The Health Law Firm Blog

Supreme Court said the federal government improperly cut more than $1 billion a year in Medicare reimbursements to hospitals. By George F. Indest III, J.D., M.P.A., Board Certified by The Florida Bar in Health Law On June 15, 2022, the U.S.

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Medicare Advantage lobby rebuts senator’s inquiry into ‘potentially deceptive’ marketing tactics

Healthcare Dive

The Better Medicare Alliance is arguing that marketing materials for MA plans are already subject to “careful regulation” and adhere to a 53-page set of federal guidelines

Medicare 232
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AHA urges DOJ to probe Medicare Advantage plans that deny care

Healthcare Dive

The hospital lobby is pushing the Justice Department to go beyond the recommendations in a new report from the HHS OIG and punish Medicare Advantage organizations that routinely deny coverage to beneficiaries

Medicare 281
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SCOTUS rejects UnitedHealth appeal of Medicare Advantage overpayment rule

Healthcare Dive

The justices declined to take up the case, leaving intact a lower court ruling that backed the 2014 CMS regulation requiring swift return of overpayments

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CVS, Rush partner on new ACO for Chicago Medicare patients

Healthcare Dive

Rush University will be the only Chicago-area academic medical center participating in CVS’ first accountable care organization in ACO REACH

Medicare 216
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Supreme Court rules in favor of HHS in Medicare disproportionate share payments case

Healthcare Dive

The highest court upheld HHS' method of calculating Medicare payments to hospitals serving a high proportion of low-income patients, rebutting hospitals’ efforts to recoup potentially billions of dollars from the program

Medicare 267
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2021 Medicare Advantage Plan Intelligence: An Early Look

Electronic Health Reporter

The Centers for Medicare and Medicaid Services (CMS) in recent months predicted both lower premiums and richer benefits for Medicare Advantage (MA) […]. The article 2021 Medicare Advantage Plan Intelligence: An Early Look appeared first on electronichealthreporter.com.

Medicare 155
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Medicare-certified hospitals must supply ownership data

Fierce Healthcare

Medicare-certified hospitals must supply ownership data. fdiamond. Tue, 12/20/2022 - 16:46

Medicare 128
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Senate passes bill extending ACA subsidies, adding Medicare price negotiations

Healthcare Dive

The Inflation Reduction Act looked dead just weeks ago until Sen. Joe Manchin, D-W.Va., announced late last month that he had successfully negotiated with Democrats to pass it

ACA 287
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Smaller rivals snap up Medicare Advantage members

Healthcare Dive

The second-largest player slashed its MA growth forecast for the year as startup insurtechs report membership gains

Medicare 237
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What You Need to Know about CMS’s 2023 Proposed Medicare Physician Payment Rule

HealthIT Answers

By Chris Emper - The heavily anticipated CMS 2023 Proposed Medicare Physician Payment Rule is a whopping 2,066 pages long and includes numerous provisions that will impact physician groups next year. Regulatory Issues Chris Emper CMS Medicare Medicare Physician Fee Schedule NextGen Healthcar

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Medical group asks Congress to offset Medicare payment cuts

Healthcare Dive

The Medical Group Management Association wants Congress to take action to help physician practices by the end of the year

Medicare 243
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Medicare Advantage plans denied some members needed care, OIG finds

Healthcare Dive

The report calls for improved oversight of MA and urges the CMS to update audit protocols and issue new guidance on medical necessity reviews performed by the plans

Medicare 311
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House progressive bill wants to take Medicare out of Medicare Advantage's name

Fierce Healthcare

House progressive bill wants to take Medicare out of Medicare Advantage's name. rking. Thu, 10/13/2022 - 16:45

Medicare 133
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CMS calls for public input to improve Medicare Advantage

Healthcare Dive

The agency wants feedback from a variety of voices on how it can strengthen the popular but increasingly controversial program

Medicare 278
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First-Ever Medicare Advantage Plan for LGBTQ+ Older Adults Launches

HIT Consultant

Medicare Advantage Plan for LGBTQ+ Older Adults. Health IT Most Popular Behavioral Healthcare Health Disparities medicare Medicare Advantage urgent care Virtual Care Virtual Visits

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Better Medicare Alliance launches bid to get rid of potential Medicare Advantage pay cut

Fierce Healthcare

Better Medicare Alliance launches bid to get rid of potential Medicare Advantage pay cut rking Wed, 02/15/2023 - 15:34

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Analysis: Medicare Advantage plans more likely to deny inpatient claims

Fierce Healthcare

Analysis: Medicare Advantage plans more likely to deny inpatient claims pminemyer Thu, 02/16/2023 - 14:16

Medicare 131