Last week, the White House Office of Management and Budget (OMB) announced that it would begin reviewing a rule that would streamline prior authorization for managed care plans, including Medicare Advantage.
The rule would put new requirements on MA plans, Medicaid fee-for-service programs, Medicaid managed care plans and exchange...
On Tuesday, the Medical Group Management Association (MGMA) released its annual regulatory burden report, which analyzes the regulatory burden placed upon providers. This year, the report highlights the issues with prior authorization, the Medicare Quality Payment Program and the No Surprises Act.
The report breaks down the responses...
It's safe to say that Medicare Advantage is now a well-established industry all its own -- within but separate from both the Medicare program and commercial insurance. With this new market dominance, the Medicare Advantage industry is now facing the same things all major industries must deal with: increased oversight, regulation and...
Medicare Advantage prior authorization reform has strong support as legislation passed through the U.S. House Ways and Means Committee last Wednesday with unanimous support.
Representative Suzan DelBene (D-Wash.), who introduced the Improving Seniors Timely Access to Care Act, said the committee vote sets the stage for a floor vote...
Last week, the Centers for Medicare and Medicaid Services (CMS) released a Request for Information (RFI), seeking comment on ways to improve Medicare Advantage and make the program more equitable, affordable and sustainable.
Medicare Advantage (MA) has been under great scrutiny lately, for policies on prior authorization, the adequacy...
This week in Medicare Advantage news, the home-based care industry is gearing up to assert itself amid concerns that home care services are being inadequately compensated. A new bill modeled on existing Texas law tries to limit the harms caused by prior authorization in Medicare Advantage plans. Also, Centene is concerned about its star...Arizona News
This week in Medicare Advantage news, prior authorization reform garners the support of the Better Medicare Alliance, Puerto Rico offers insight into the future of the MA program, a CMS rule on third-party marketing goes into effect and we share some acquisition news.
Last week, the Better Medicare Alliance, the largest lobby for...
The fight between providers and Medicare Advantage (MA) plans over prior authorization is heating up as the American Medical Association (AMA) and the American Hospital Association (AHA) continue their appeals to government agencies to take action against plans.
Last Friday, the American Hospital Association asked the Centers for...
Last Thursday, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a report that strongly suggests that Medicare Advantage (MA) plans delayed or denied medical treatments and procedures to beneficiaries that met the Medicare coverage requirements.
Analysts with the Office of the Inspector...
The increasing burden of prior authorization, as well as the rise of “fail first” policies has become costly and harmful for patients – so much so that the American Medical Association (AMA) has engaged a law firm to pursue curtailing prior authorization.
According to the American Journal of Managed Care (AJMA), Barbara...
Medicare Advantage now manages the care for 45% of all Medicare beneficiaries, which demonstrates a +3% point improvement in penetration over 2021 and 9% increase in total enrollment year-over-year. Due to these rapidly increasing enrollment numbers, the program is dynamic and under regulatory scrutiny as it responds to patient...
A bipartisan group of senators, including Senators Kyrsten Sinema (D-AZ) and Mark Kelly (D-AZ), sent a letter to the Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure last Friday, warning against any potential cuts to the Medicare Advantage (MA) program. The letter comes as Democrats look for places to...National News
Analysis released by insurance lobbyist America's Health Insurance Plans (AHIP) shows that adding vision, dental and hearing benefits to traditional Medicare will increase premiums and plans for Medicare Advantage plans unless adjustments to Medicare Advantage payments are included.
Congress is currently considering adding the...News
Physicians, residents and medical students at the Special Meeting of the AMA House of Delegates adopted new policies that aim to target peer-to-peer review of prior authorization decisions and the specific burden of prior authorization during a public health emergency.
This came after years of advocacy to streamline burdensome prior...CMS Rules
Medicare's older adults still like their coverage and report fewer cost-related problems than privately insured adults ages 50 to 64, despite receiving similar care to that age bracket.
The study from Kaiser Family Foundation said that rapidly growing healthcare spending is of concern for consumers and the relatively high prices from...CMS Rules
Last Friday, the Centers for Medicare and Medicaid Services (CMS) approved a final rule requiring payers to build application program interfaces to support data exchange and streamline prior authorization. Medicaid and the Children’s Health Insurance Program (CHIP); healthcare exchange plans are also required to comply with the...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) proposed a new rule to streamline prior authorizations and improve electronic healthcare data transfers between doctors, patients and insurance companies. The rule will require payers involved in certain government programs to build apps for the purpose of this exchange and prior...CMS Rules
The new model now requires providers to get prior authorization (PA) before scheduling a non-emergent ambulance transport for a patient and pays ambulance services for taking patients to non-hospital facilities.
A ride in an ambulance can cost between hundreds and thousands of dollars depending on locations, services and the...National News
During a speech at the American Medical Association's National Advocacy Conference this month, CMS Administrator Seema Verma characterized prior authorization (PA) as "indefensible" and a "longstanding problem" in healthcare. Recent analysis shows alarming inefficiencies.
This year, our efforts around innovation and reducing...Arizona News
