Medicare Advantage
publication date
Payer
Medicare Advantage Insurers Face New Curbs on Overcharges in Trump Plan That Reins in Payments
Federal audits have shown for years that many health plans' billing practices don't hold up to scrutiny.
Revenue Cycle
CMS Signals MA Payment Slowdown as Provider Frustration With The Plans Continue to Mount
The proposal reinforces concerns that MA incentives remain misaligned with clinical reality.
Revenue Cycle
Chart Reviews Boost Medicare Advantage Payments for 1 in 6 Enrollees
A new KFF analysis reveals that retrospective chart reviews are a primary driver of risk-adjusted payments for Medicare Advantage insurers,...
Innovation
Study: Virtual Care Visits Dropped During the Shutdown
The news comes as CMS reaffirms reimbursement during the shutdown and reverses a much-criticized policy on listing the provider's home...
Payer
Complaints About Gaps in Medicare Advantage Networks Are Common. Federal Enforcement Is Rare.
Government documents show CMS does little to enforce long-standing rules intended to ensure about 35 million plan members can see...
Payer
Contributed Content: Beyond Coverage: How Clinical Strategy and Engagement Are Shaping the Future of Medicare Advantage
The next chapter of Medicare Advantage is being defined by the most forward-thinking plans?those aligning clinical strategy with member engagement...
Payer
Private Medicare, Medicaid Plans Exaggerate In-Network Mental Health Options, Watchdogs Say
More than half (55%) of mental health professionals listed as in-network by Medicare Advantage plans were not providing such care.
CFO
Infographic: 3 Notes on the Medicare Advantage Prompt Pay Act
A new piece of legislature might ease Medicare Advantage reimbursement struggles for providers.
Payer
AI Will Soon Have a Say in Approving or Denying Medicare Treatments
The pilot program, designed to weed out wasteful, 'low-value' services, expansion the federal use of prior authorization.
CEO
Cleveland Clinic's Q2 Margin Demonstrates Financial Rebound
The health system posted a 5.6% operating margin in the second quarter to fuel a sharp turnaround from a duration...
Payer
Breaking Down Why Medicare Part D Premiums Are Likely To Go Up
Increases are expected to mainly affect stand-alone Part D plans, not the drug coverage offered as part of Medicare Advantage.
Revenue Cycle
What's Happening with DOJ Investigations into UnitedHealth?
UnitedHealth Group has confirmed it is under investigation by the DOJ. For healthcare leaders, the multiple probes into the payer...