Medicare Advantage
publication date
Clinical Care
Prior Authorization Fixes Still a Medicare Priority, Says CMS Chief
Process needs to be less burdensome, Verma says
Finance
Humana Projects Additional 500K Medicare Advantage Members for 2019
Humana also reported $16.2 billion in total revenues, an increase of $2 billion year-over-year.
Strategy
Azar and Verma: Competition, Value-Based Models Needed to Fix Our Cost Problem
Both the HHS secretary and CMS administrator cited the competition among Medicare Advantage plans as a model of success.
HHS OIG Offers 25 Ways to Reduce Healthcare Waste and Fraud
OIG says these recommendations 'would most positively affect HHS programs in terms of cost savings, program effectiveness and efficiency, and...
Finance
Missouri Firm With Silicon Valley Ties Faces Medicare Billing Scrutiny
A recent HHS audit and a whistleblower lawsuit, have put Essence scrutiny. Medicare is conducting a separate audit.
Finance
Medicare Advantage Overbills Taxpayers By Billions A Year As Feds Struggle To Stop It
Officials have known for years that some Medicare Advantage plans overcharge for treating serious medical conditions they cannot prove their...
Prior Authorization Bill Expected in Congress This Week
The legislation would set standards for Medicare Advantage plans.
Finance
Medicare Advantage Premiums Fall 33% in Q1
When zero-dollar premium plans were removed, costs still dropped by 13%, according to a survey from eHealth.
Strategy
Undaunted By Trump's ACA Threats, Centene Plans to Forge Ahead
Centene's CEO told analysts last month the Trump administration's support of invalidating the ACA shouldn't affect the health insurer's day-to-day...
Finance
Sutter Health, Affiliates to Pay Back $30M for Medicare Advantage Overpayments
Federal prosecutors allege that the Sacramento-based health system and its affiliates submitted unsupported diagnosis codes for patient encounters with Medicare...
Finance
MA Plans Permitted to Cover Supplemental Benefits Next Year
The final policy also gives Medicare Advantage plans a 2.53% pay bump for fiscal year 2020, up from the 1.59%...
Strategy
Shift to Medicare Advantage Ratchets Up Pressure on Hospitals
The move to private Medicare Advantage takes hospitals further away from fee-for-service medicine, putting pressure on these providers to improve...