Not updated since 1999, the new guidance applies to all individuals and entities involved in the healthcare industry and serves as the Office of Inspector General's updated and centralized source of voluntary compliance program guidance for Medicare Advantage (MA). Entities and individuals can use the ICPG to help identify risks and...White Papers, E books, Reports and more
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a new report demonstrating that Medicare Advantage (MA) and Medicaid managed care organizations (MCOs) coverage of behavioral health programs falls short of meeting enrollee needs.
The focus of the report was on network adequacy, which poses...Top of The Day
Between new auditing policies from the U.S. Department of Health and Human Services, President Joe Biden's consumer protection initiatives curbing the use of third-party marketing organizations and Congressional reports on excessive spending, Medicare Advantage has had a pretty tough time. So the MA lobby, the Better Medicare Alliance...CMS Rules
In December, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule that would require all health plans, including Medicare Advantage plans, to limit prior authorization deliberations to seven days. On Monday, the public comment for that rule closed.
Many providers believed that the rule doesn't go far enough,...National News
Medicare Advantage and the hundreds of investors pumping venture capital into new MA startups rely on one thing: MA growth. For the past several years, MA has been on a quick trend upward, but as it currently only captures under 50% of the market, some are left wondering if the seemingly endless demand isn't just a giant investment...National News
Social Determinants of Health (SDOH) may have a more significant influence on health outcomes than clinical care. The focus on SDOH reflects broader trends in the U.S. healthcare system.
Food access, transportation options and other SDOH account for up to 55% of an individual’s health outcomes. To better understand these factors,...Arizona News
October 1 marked the start of the shopping season for Medicare beneficiaries seeking to compare Medicare Advantage (MA) plans prior to purchase during open enrollment October 15 through December 7, 2019.
More than a dozen insurers are offering more than 100 plans in Arizona and every eligible shopper in the state can access a 2020 MA...
