Throughout 2021, The Department of Justice (DOJ) cracked down on healthcare fraud, with special emphasis on fraud related to Medicare and Medicaid. As the population ages, Medicare Advantage plans have increased in popularity, leading to a direct increase in Medicare related fraud. The Department of Justice’s focus on healthcare fraud...Arizona News
In 2018 and 2019, CMS paved the way for supplemental benefits in MA plans by granting more flexibility for insurers. They have taken advantage.
A recent analysis from Milliman found that the number of Medicare Advantage plans across the country that offered at least one supplemental benefit increased by 64% from 2020 to 2021....National News
Last week, CMS announced it is adjusting payouts from its Accelerated Payment Program (AAP) which was recently expanded to help healthcare providers and suppliers address COVID-19 related costs.
In a press release, CMS detailed that Medicare payments to Part B suppliers were immediately cut off, while the agency is...Arizona News
In a recent study, the American Journal of Managed Care (AJMC) investigated the rate of utilization and spending under Banner Health's Medicare and commercial insurance contracts in Maricopa County.
The amount of financial risk assumed by the delivery system under the contracts varied and study authors found that within Medicare,...Arizona News
The Centers for Medicaid and Medicare Services' (CMS) new mandates issued on Monday is requiring states and Medicaid managed care organizations (MCOs) to make changes to their Medicaid drug utilization review program by the end of the year. The guidance includes setting prescription limits for all opioid drugs and monitoring...Arizona News
Skilled nursing facilities (SNF) may secure a $887 million increase in payments by fiscal year 2020 under an April 2019 proposed rule aiming to update the payment rates and quality programs to align with value-based care models.
Due to a three percent market basket increase factor, paired with a 0.5 percentage point reduction for...Arizona News
All eyes will most likely be on the Centers for Medicare and Medicaid Services (CMS) as the agency sparks conversation of possibly using Medicaid to pay for housing. Healthcare is continuing its move toward value-based care and judging by a speech delivered by Health and Human Services (HHS) Secretary Alex Azar last week, the government...National News
Medicare Advantage enrollment is projected to rise to 38 million, or 50% market penetration, by the end of 2025.
Anthem, Humana and WellCare Health Plans are signaling plans to aggressively grow their Medicare Advantage businesses with the help of mergers and acquisitions. The three health insurers are in a competitive battle with...National News
Testimony presented at CMS Stakeholder Meeting in Baltimore.
MGMA outlined the importance of the agency promulgating a regulation to establish a national standard for electronic attachments. Attachments are typically used during a practice's revenue cycle in support of claims, prior authorization, referrals, and other transactions....
