Tag: Medicare Advantage

Bill would automate prior authorization through Medicare Advantage plans

Congress is considering legislation that would automate the prior authorization process within Medicare Advantage plans. Home health agencies and other providers under Medicare Advantage plans must receive prior authorization before they can visit a patient, which has caused some frustration among agencies. For example, a patient is being discharged from the hospital to home health […]

CMS announces decline in 2020 Medicare Advantage premiums

CMS announced September 24 that “Medicare Advantage [MA] premiums in 2020 are expected to decline 23% from 2018 while plan choices, benefits and enrollment continue to increase.” This average monthly premium will be the lowest rate in 13 years. Accompanying this announcement, for the first time in a decade, a new Medicare Plan Finder was […]

MA patients had shorter course of rehab, better discharge an outcomes

A recent study compared Medicare fee-for-service beneficiaries to Medicare Advantage beneficiaries, both with hip fractures, to determine if payment structured changed the nature, timing, and outcomes of care. This was a retrospective cohort study to examine differences in health service utilization and outcomes between FFS and MA patients in SNFs following hip fracture hospitalization during […]

CMS outlines some soon-to-be covered services in memo on Medicare Advantage

Brought to you by Home Health Line. In-home support services and adult day care services are on the list of supplemental benefits to be allowed under Medicare Advantage plans in 2019, according to a recent CMS memo. Home-based palliative care, support for caregivers of enrollees, medically-approved non-opioid pain management, stand-alone memory fitness benefit, home bathroom […]

Ambulances out, share riding and alternative services in?

While it’s concerning that some people are apparently calling ride-share services like Uber when they need to get to the hospital in an emergency, others are wondering if ride-sharing or alternative services have their place in non-emergency medical transport. Many  people call ambulances when they need treatment, even if it’s not an emergency, because they […]

New study finds that MA beneficiaries use home health less

A new study by the American Journal of Managed Care finds that Medicare Advantage (MA) beneficiaries use home health less often than fee-for-service (FFS) counterparts. However, regional factors affected utilization greatly, independent of insurance status. The study used the 2010 and 2011 Outcome and Assessment Information Set to identify all home health episodes begun in […]

CMS released final Medicare Advantage and Part D prescription drug program changes

The Centers for Medicare & Medicaid Services (CMS) released final Medicare Advantage (MA) and Part D Prescription Drug program changes for 2016 that provide fair and accurate payments to plans, and encourage the delivery of high-quality care for all populations. The Medicare Advantage and the Part D Prescription Drug programs’ enrollments and quality continue to […]

Ask our Experts about Medicare Advantage: Claims and Denials

Do you have a question about a Medicare Advantage claim or a denial? Do you have issues or concerns specifically regarding Medicare Advantage? Ask it here, and have it answered by our Medicare experts! Leave a question in the comments, or email managing editor Olivia MacDonald @ omacdonald@hcpro.com.