At its December 4 meeting, the Medicare Payment Advisory Committee (MedPAC) reviewed payment data on payment adequacy and potential payment updates and recommendations for its March 2026 report to Congress. This discussion included an update on post-acute care payments and an assessment of hospital performance.
MedPAC commissioners...
On Thursday, the Senate Homeland Security Permanent Subcommittee on Investigations (PSI) published a report on Medicare Advantage denials for post-acute care services. The study showed that the three largest Medicare Advantage insurers, UnitedHealthcare, Humana and CVS Aetna, significantly raised the rate of prior authorization denials...
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) announced last month that it would investigate the use of prior authorization in denials for post-acute care by Medicare Advantage plans.
In the new audit, OIG plans to look into processes for reviewing prior authorization requests for post-acute...
The Medicare Payment Advisory Commission (MedPAC) published its annual June Report to Congress, which includes suggestions to unify payment methodologies for post-acute care, address issues within Medicare Advantage, and lower telehealth payments.
The MedPAC recommendations for streamlining payment methodologies for skilled nursing...
Last week, LeadingAge published a white paper that describes the difficulties Medicare Advantage members face accessing payment for post-acute care services.
The white paper, "Fulfilling the Promise: Medicare Advantage," identifies the issues that many beneficiaries face when attempting to access benefits, such as delays, unnecessary...
This week in value-based care, CMMI director Elizabeth Fowler defends criticism of the ACO REACH payment model, CMS improves ACO quality care reporting and data aggregation, the White House moves to support a value-based program for skilled nursing facilities, FQHCs struggle to keep up with systemic transformation and MedPAC moves to...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) updated its guidance for nursing home visitations during the COVID-19 pandemic this week. Although the guidance relaxes previous regulations, the agency notes its concern for the vaccination rates of nursing home employees. Unfortunately, unlike most other areas of the medical...Arizona News
Hospitals and providers participating in Medicare quality value-based purchasing programs received unprecedented relief on Sunday from a Centers of Medicare and Medicaid Services (CMS) announcement that relaxes reporting requirements and extends data submission deadlines.
The action is part of the Trump Administration's response...Arizona News
Starting Oct. 1 therapy payments to nursing facilities will shift to a value-based model, emphasizing patient needs over the amount of services provided. The Patient Driven Payment Model (PDPM), a more individualized approach, aims to reduce inflated billing by basing payments on patient's medical characteristics.
The new approach...
