CostFlex Systems, Inc.’s Post

Medicare Advantage now covers over half of all Medicare beneficiaries, but this growth could negatively impact hospital margins, according to an S&P Global Ratings report. Hospitals, which rely heavily on Medicare revenue, are particularly vulnerable to reimbursement risks and the complexities of prior authorization requirements from MA plans. With insurers prioritizing margins, providers may face increased financial pressure, especially at smaller and rural hospitals. The challenging environment could lead to tough contract negotiations, potentially forcing some providers to terminate contracts or even close locations. #healthcare #medicareadvantage

With downward pressure on Medicare Advantage plans reimbursement, here are 10 critical questions for providers and payors regarding MA. 11th question: Where do you go from here to deliver Value-based care to members? #valuebasedcare #MA #Medicareadvantage #Ruralhospital #BeckersHealth

Medicare Advantage (MA) has been under scrutiny lately, but is the grass really greener on the other side? Dr. Sachin Jain, CEO of SCAN Group, a major MA insurer, argues that nostalgia for traditional Medicare might be misplaced. Here's the gist: - A recent article criticized MA for "less care at a higher cost." Dr. Jain says both programs have issues, and MA might actually be closer to the original goals of Medicare. - Traditional Medicare, according to Dr. Jain, incentivizes overtreatment because there's no cost control. MA, on the other hand, focuses on value and has clear quality measures (star ratings) for members to see. - Dr. Jain acknowledges room for improvement in MA, particularly in risk adjustment and overly-customized benefits. He proposes solutions like: - Better coding alignment between MA and traditional Medicare by CMS. - Standardizing some benefits based on existing supplemental Medicare coverage. - Testing longer enrollment cycles in MA through CMS' Innovation Center to allow for better care coordination. Learn more: https://hubs.ly/Q02CJnXK0

Previously we covered the financial implications of Centers for Medicare & Medicaid Services Star Ratings for payer organizations offering Medicare Advantage plans. In our most recent Genzeon blog post, we describe the challenges in maintaining ratings year to year, and what the main factors are for these ratings. Read more: https://lnkd.in/e7uwYCfU #starratings #medicareadvantage #hipone

Some more compelling reasons to question managed Medicare…

Privatized Medicare Advantage plans have raised costs for Medicare by $612 billion since 2007, including $82 billion last year alone, according to congressional advisory group MedPAC. Managed Medicare membership continues to grow exponentially, while the costs to taxpayers also grows exponentially…and, these plans are the most profitable in the entire managed care sector…which should be a red flag to all consumers and healthcare professionals. #healthcare #leadership #managedcare Honor Aging

The Medicare Payment Advisory Commission (MedPAC) faced contention as member Brian Miller accused leadership of bias in a report on Medicare Advantage (MA) plans' market dominance, suggesting it was politically motivated for a rate cut.   The report highlighted concerns about Medicare funds flowing to MA plans, citing increased spending and dominance by a few companies. While Miller criticized the report, others defended its complexity.   The Better Medicare Alliance raised concerns about methodology. Despite challenges, MA enrollment has grown to 52% of beneficiaries.   In response to the evolving landscape, our professional team can assist healthcare entities and communities in navigating MA complexities, offering expertise in billing, coding, and compliance to ensure optimal reimbursement and quality care.   We are the One!   https://lnkd.in/gTgRcZC4   #revenuecycle #revenuecyclemanagement #priorauthorization #medicalbilling #medicalcoding #healthcare #healthcaretechnology #accountsreceivables #denialmanagement #consulting #management #implementationpartner MedPage Today

The Centers for Medicare & Medicaid Services recently released v4.1 of their #WCMSA Reference Guide and v1.6 of their Self-Administration Toolkit. Read our latest #blog by Dawn Dietz for an overview of the changes in each guide. https://lnkd.in/gaZjtFcj #MSPcompliance #MedicareSetAsides #MedicareCompliance #MSASelfAdministration

🔷Cigna is out of Medicare Advantage, Medicare PDP and all things Medicare. 🔷It remains a powerhouse for commercial group and ERISA plans but Medicare ... not so much. 🔷✅On the other hand, HCSC has proven itself able to navigate successfully in several markets in the US. 🔷While the immediate impact to current Cigna MA/MAPD and PDP members is likely negligible, it is more important to consider the plans for HCSC to be more competitive on a national (not just regional) market(s) against the likes of UHC, Humana, Molina, Elevance, etc., 🔷😳In other news, Humana's had quite a run of bad luck lately... missing growth goals and getting smacked on recent earnings reports. ➡️➡️‼️So who does that leave standing....yep...you guessed it!

WHY MORE ORGANIZATIONS ARE TERMINATING MEDICARE ADVANTAGE CONTRACTS Medicare Advantage plans have one objective, simply earning profits and return on investment. Every business deserves and needs to generate profits. However, the manner in which Medicare Advantage plans set out to earn a profit by reimbursing low amounts, raising administrative burden for providers, issuing egregious denials, wanting to pay observation rates when inpatient is warranted, hiring third party bottom feeder firms to second guess physician's documented diagnoses, and clawing back monies after payment on the basis of medical necessity, clinical validation, and DRG downgrades, has reached a tipping point. It is not difficult to see why large health systems as well as other healthcare entities are distancing themselves from these "profit seeking" MA plans once and for all. This should be complemented by continuing to educate Medicare beneficiaries on the pitfalls of these MA Plans. They promise beneficiaries a wide array of enticing benefits until the beneficiaries try to access these benefits. #benefits, #MAPlans, #profitsfirst, #patientcaresuffers,#lowreimbursement, #administrativeburden https://lnkd.in/eFhc_HbN