Revenue CycleThe Solution is 20/20: Ophthalmologists Ask CMS to Suspend Certain Prior Auth Policies
The AAO addresses prior authorization processes that the group says delay care.
PayerMedicare Advantage Enrollees Vulnerable to Financial Challenges
Research reveals the financial discrepancies between Medicare Advantage (MA) and Medicare Supplement beneficiaries.
Revenue Cycle'Significant Ramifications': Medical Group Opposes HCC Coding Changes
"Modifying the HCC model is not a simple technical update or revision," the AMGA says.
PayerOIG: Identifying Denied Claims in Medicare Advantage Needed to Combat Fraud
Medicare Advantage (MA) plans aren't required by CMS to include indicators in their encounter data, unlike Medicare and Medicaid.
PayerProviders, Not Just Payers, Push Back Against Medicare Advantage Pay Rule
Both sides have raised concerns to CMS over the ramifications of the Medicare Advantage (MA) advance notice rule.
PayerCMS Issues Payment and Coverage Guidance as Pandemic Waivers Approach Expiration
The agency has issued a fact sheet addressing flexibilities authorized during the COVID-19 federal public health emergency (PHE).
PayerMedicare Advantage Members Less Likely to be Hospitalized Than Medicare Beneficiaries
However, Medicare Advantage (MA) patients experience higher rates of emergency department (ED) direct discharges and observation stays.
PayerMedicare Advantage Margins Doubled Other Insurance Markets
Analysis of health insurer financial performance in 2021 finds Medicare Advantage (MA) plans had significantly higher gross margins.
PayerMost Medicare Members Feel Policymakers Aren't Listening to Their Needs
A new survey finds high satisfaction with Medicare plans, but plenty of concern over costs and future access to benefits.
PayerHumana to Withdraw From Employer Group Commercial Business
The major payer will concentrate its focus on its Medicare and Medicaid health plan offerings.
Revenue CyclePrior Auths 'Delay, Deny, And Disrupt': Major Medical Societies Show Support for Reform
118 leading medical societies united to defend proposed prior authorization reforms.
PayerMedicare Advantage Enrollment Shot Up 337% as Payment Policy Fell Behind
Plans have experienced exponential growth, but researchers caution that the outdated payment policy has ramifications.