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Medicare Advantage has grown rapidly in recent years, with 32.8 million people (54% of the eligible Medicare population) now enrolled in an MA plan. Health systems are grappling with various challenges within the program, such as excessive prior authorization denial rates and slow payments from insurers, but some organizations have positioned themselves for success. #Medicare #HealthcareTech #HealthSystems

Medicare Advantage has grown rapidly in recent years, with 32.8 million people (54% of the eligible Medicare population) now enrolled in an MA plan. Health systems are grappling with various challenges within the program, such as excessive prior authorization denial rates and slow payments from insurers, but some organizations have positioned themselves for success. #Medicare #HealthcareTech #HealthSystems

Let our recent blog help you discover the latest insights about Centers for Medicare & Medicaid Services Star Ratings and Risk Adjustment in the Medicare Advantage landscape! Learn how CMS evaluates health plan performance with respect to Star Ratings. Plus it offers to Explore the upcoming adjustments in the risk adjustment model, aiming to ensure fair compensation for health plans based on their members' health risks. The recent blog also gives a perspective on how Medicare Advantage plans prepare for stricter scrutiny as regards their risk adjustment program and the significance of the Tukey outlier deletion method in the 2024 Star Ratings. Don't miss out on these insightful discussions & more in our just-released blog! Stay tuned for more updates and join the conversation to shape the future of healthcare - https://bit.ly/4d4oSAz . . . #medicareadvantage #starratings #healthplans

Fee-For-Service vs. Value-Based Care – what exactly is the difference?   Value-based care models incentivize physicians to focus on the quality of service they provide each patient, instead of the quantity that’s associated with the traditional fee-for-service model, resulting in better health outcomes for patients and improved satisfaction for physicians.   Amid the growing shift from fee-for-service to value-based care, with the Centers for Medicare & Medicaid Services’ goal to transition all Medicare beneficiaries to a total care model by 2030, learn more about the differences between each model of care and why #ValueBasedCare is the future of U.S. health care:

A growing number of health systems are considering dropping #Medicare Advantage plans, citing burdensome authorization processes, high denial rates, and inadequate reimbursement. A survey by the Healthcare Financial Management Association (HFMA) found that 16% of health systems plan to stop accepting at least one Medicare Advantage plan within two years, with another 45% considering it. Health systems argue that Medicare Advantage plans make it difficult to provide quality care due to strict cost controls. Impact on Patients: While some health systems are dropping plans, Medicare Advantage remains popular with beneficiaries, boasting a 95% satisfaction rating in 2023. Dr. Sachin Jain, CEO of a large Medicare Advantage insurer, warns that health systems dropping out could disproportionately impact low-income beneficiaries who rely on these plans. Learn more: https://hubs.ly/Q02qPyq40

Attention healthcare industry professionals! 🚨 Pre-market turbulence hits U.S. health insurers as Medicare Advantage reimbursement rates remain unchanged. With margins potentially squeezed next year, it's crucial for us to stay informed and adaptable in navigating this landscape. #medicare #medicareadvantage #healthcare #actuary

It's a good question, and one everyone is asking, but is it the right question at the right time? Medicare Advantage needs to get on the same page with Healthcare providers. Are the providers being heard? Extremely slow pay and excessive denials must be address so that the current failing processes within Medicare Advantage, can be corrected before expanding their footprint; otherwise they risk repeating failing internal processes that are clearly broken and not efficient. It's the members that suffer in this scenario. Let's hear from you. What ideas do you have for addressing the issues? https://lnkd.in/dvZyqJPA

United Healthcare continues to violate ERISA and harm providers and patients by cross-plan offsetting with their Medicare Advantage plans. What is cross-plan offsetting? See below: Cross-plan offsetting is a so-called “bulk-recovery practice” that UHC has used for a number of years to collect overpayments made to providers. Under ERISA, a health plan may recover overpayments made to a participant or service provider by requesting a refund or reducing future benefits or payments. However, with cross-plan offsetting, a third party administrator (TPA) seeks to recover an overpayment to a healthcare provider under one health plan that it administers by underpaying or “offsetting” an amount owed to the same provider under a different health plan it administers. Essentially, the TPA uses the assets of one health plan to pay or reimburse benefits provided under another health plan in violation of ERISA’s exclusive benefit rule. If an insurer TPA uses assets from a self-insured plan to reimburse overpayments in a fully insured plan, the TPA’s actions may violate ERISA’s prohibition against self-dealing. In addition, when cross-plan offsetting occurs, a healthcare provider may balance bill a patient because the patient’s plan has not paid the provider’s bill in full. This risk is higher with out-of-network healthcare providers that do not have contracts with the TPA. Despite multiple court rulings and the Department of Labor citing that cross-plan offsetting is a violation of ERISA sections 404 and 406 respectively, UHC continues to be a bad actor. We have escalated this issue to UHC's legal team and their stance is that they are going to keep doing it until penalized enough to stop. If this is happening to your practice, notify the Department of Labor (DOL phone #: 866-444-3272) and instruct your affected patients to do so as well. Feel free to reach out to us for more specific details.

Health Data News Roundup: NCQA Annual Health Plan Ranking; Payer Health IT Spending Trends; and the State of Medicare Advantage in 2024 #HIT #HealthPayers #Payers #HealthData https://bit.ly/4gydWNh

💡 A recent article from Digital Health Insights highlights the CMS Interoperability and Prior Authorization Final Rule, recently finalized by the Center for Medicare and Medicaid Services. This significant advancement is designed to enhance prior authorization procedures and streamline the electronic exchange of health data, relieving the burden on stakeholders and potentially saving an estimated $15 billion over the next decade. Learn more about how this change is poised to revolutionize healthcare delivery: https://lnkd.in/ge2vnAfM #DigitalHealthLeaders #CMS #Interoperability