The agency estimates that there were $28.83 billion in improper payments to traditional Medicare, which it estimates are down from $31.7 billion in 2024. The Center for Medicaid & Medicare Services acknowledges improper payments are not indicative of fraud or abuse but are typically the result of clerical error.
The agency looked...
Medicare Advantage enrollees spent on average $3,486 less on out-of-pocket health care costs than Fee-for-Service Medicare enrollees in 2022, according to an analysis by Better Medicare Alliance and conducted by ATI Advisory.
Between 2021 and 2022, average out-of-pocket health care spending per beneficiary increased in both programs;...
A new study from the Kaiser Family Foundation (KFF) looked at spending trends among people who chose to disenroll from Medicare Advantage during the Medicare open enrollment period and found a difference of $2,585 (27%) in Medicare spending per person, on average, between the two groups in 2022.
Medicare beneficiaries with pneumonia...White Papers, E books, Reports and more
A new report from the Medicare Payment Advisory Committee (MedPAC) demonstrates that Medicare Advantage expansion is having a negative effect on hospital finances as MA-related revenue is lower than that of fee-for-services.
The MedPAC report reviewed claims data for 24 million beneficiaries enrolled in both MA and FFS and found that...
MedPAC is concerned about the adequacy of fee-for-service (FFS) Medicare rates and the sunsetting of participation bonuses for clinicians in advanced alternative payment models (A-APMS). Commissioners also discussed the Medicare Advantage PA problem, considered how to lower FFS rates for inpatient rehabilitation facilities and much more...
A new white paper by Harvard Medical School and Inovalon, a company that provides health data aggregation services, compared healthcare utilization and expenditures between Medicare Fee-for-Service (FFS) and Medicare Advantage beneficiaries.
The paper, "Utilization and Efficiency Under Medicare Advantage vs. Traditional...National News
The Medicare Annual Wellness Visit (AWV) came into effect as part of the 2010 Affordable Care Act and includes cognitive impairment detection. In the beginning, initial adoption of AWVs among beneficiaries was low especially among non-white, and rural members.
The law doesn’t provide specific guidelines for assessment of cognitive...National News
The Centers for Medicare and Medicaid Services (CMS) is requesting feedback on the design of an episode-based payment model on behalf of the Center for Medicare and Medicaid Innovation (CMMI/Innovation Center).
Episode-based payment models are designed to address inadequacies in traditional Medicare through bundling and incentive...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) published a memo concerning a crackdown on improper claims for skilled nursing facilities. CMS also announced that it would begin a demonstration for inpatient rehabilitation facilities in Alabama that will allow all Medicare claims to be subject to review.
As of June 5, all SNFs...
With cases of COVID-19 back on the rise in Arizona and across the country, epidemiologists and experts are asking if yet another Omicron surge looms on the horizon.
In Arizona, nearly 5,500 new cases were recorded over the past week. There were 41 new deaths related to COVID-19 in Arizona, bringing the state total to 30,320. These...
The success of Medicare Advantage (MA) can't be understated. In the last 11 years, the program has grown to represent nearly 50% of the Medicare-eligible market, a benchmark it will likely pass within the next year.
Arizona MA growth reflects the program's national success. At the Hertel Report's 2020 Winter State of the State, Dan...
On Monday, August 23, the Food and Drug Administration (FDA) gave full approval for the Pfizer-BioNTech COVID-19 vaccine. The vaccine will now be marketed under the name Comirnaty and will be available to prevent the disease in individuals 16 years and older. For now, the vaccine will remain under emergency use authorization (EUA) for...
This week, the Kaiser Family Foundation released its annual analysis on Medicare Advantage, enrollment and trends for 2021; J.D. Power published its annual U.S. Medicare Advantage study and MedPAC's June report received some criticism from stakeholders.
KFF Analysis
Kaiser's annual analysis of the Medicare Advantage market demonstrated...National News
This week, COVID-19 continues to impact the data collection and maintenance of Medicare Advantage and Medicaid Managed Care programs. MedPAC reasserts its findings that Medicare Advantage costs the government more than fee-for-service and Oklahoma asks "is now really the time to be privatizing Medicaid?"
Medicare Advantage
The...National News
The Centers for Medicare and Medicaid Services will end its suspension of audits on claims as of August 3, according to an FAQ released by the organization this week. CMS paused audits for fee-for-service claims on March 30 as part of the federal response to the COVID-19 pandemic.
The fee-for-service claims reviews, which are...White Papers, E books, Reports and more
Researchers with UnitedHealth Group reported average annual health care costs for a 72-year-old MA beneficiary of average health are $3,632, compared to up to $5,960 for Medicare fee-for-service (FSS) beneficiaries. UnitedHealthcare is Arizona's leading Medicare Advantage (MA) insurer.
The UHG report brought attention to the fact...
