Medicare Advantage insurers are having a tough time. Humana was forced to refile its lawsuit against the Centers for Medicare and Medicaid Services (CMS) over inappropriate star ratings awards as it scales back its use of prior authorizations. Meanwhile, the American Hospital Association (AHA) testified in Congress about the problems...
More insurers are planning to jump the Medicare Advantage ship, or at least scale back program participation in 2025.
It's anticipated that next year will bring fewer MA plans and supplemental benefit offerings following increased oversight by the Biden administration on overpayments to MA companies, which will lead to a projected...
Earlier this year, two judges ruled that the Centers for Medicare and Medicaid Services (CMS) had improperly calculated Medicare Advantage scores and subsequent bonuses under the Star Ratings program last October. This week, CMS issued revised quality ratings for 2024, with a number of plans receiving far higher ratings and bonuses than...
SCAN Health Plan won a massive case against the Centers for Medicare and Medicaid Services (CMS) this week when Judge Carl J. Nichols of the U.S. District Court for the District of Columbia ruled that the agency improperly calculated SCAN's star ratings scores which caused the company to lose out on millions in bonuses.
SCAN will be...
CAHPS Hospice Survey measure scores are calculated across eight rolling quarters and are published quarterly for all hospices with 30 or more completed surveys over the reporting period. The Hertel Report compiled the data and identified all Arizona hospice providers with star ratings from a low of 1 to 5, which denotes the highest...
The Alliance of Community Health Plans (ACHP) demanded a major overhaul of Medicare Advantage and is asking the Centers for Medicare and Medicaid Services (CMS) and Congress to change the program's regulatory aspects.
ACHP calls the new plan MA for Tomorrow, and will break down policies into five areas: improving quality, streamlining...
Last week, the Centers for Medicare and Medicaid Services released a final rule taking aim at prior authorization and its use in Medicare Advantage. The rule also makes changes to the star ratings program and marketing reforms.
The rule stipulates that once a health plan grants prior authorization for a service, the approval will...Arizona News
Each year, more than 32,000 older adults die from a fall and the number is climbing. Last week, a University of Arizona assistant professor’s solution impressed the National Institutes of Health (NIH), which is now funding a $580,000 study that may finally make a dent in reducing the number of falls annually reported by those age 65...
The data usually is released in April but was delayed due to a calculation error. Updated July 27, 2022, the Overall Hospital Quality Star Rating summarizes 47 quality measures across five categories to create a single, star rating for hospitals across the nation. Most Arizona hospitals, like the majority in the United States, earned...
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...CMS Rules
It's no secret that the Biden administration is planning to implement mandatory staffing levels in nursing facilities that are reimbursed through Medicare and Medicaid. In the most recent step to announcing this measure last Thursday, the Centers for Medicare and Medicaid Services (CMS) published new guidance on staffing measures tied to...National News
The Medicare Payment Advisory Committee (MedPAC) sent its annual March report to Congress on Medicare fee-for-service (FFS) payment systems, Medicare Advantage (MA) and the Medicare prescription drug program (Part D). The report contains analysis of the COVID-19 pandemic's influence on Medicare spending and the subsequent sustainability...Arizona News
The Centers for Medicare and Medicaid Services (CMS) announced the release of updated hospital performance data on the Hospital Compare website and data.medicare.gov. The agency also announced on Feb. 28 that it would post potential changes to the star rating methodology for public comment and feedback in attempts to improve the way...Arizona News
The 85-bed facility ranks among the worst in the country, receiving a one-star rating from the U.S. Department of Veteran Affairs.
Providing short-term rehabilitation and stabilization, the Prescott Community Living Center demonstrated a lack in quality of care with 45 percent of patients claiming to have moderate to severe...
