Tag: Medicare Advantage
Poll respondents on MA plans: ‘It’s just too much’
January 3, 2025Theresa Flaherty, Managing Editor
YARMOUTH, Maine – When it comes to Medicare Advantage, respondents to a recent HME Newspoll have two predictions: The numbers of beneficiaries enrolled in these plans will increase under the new administration of President-elect Donald Trump, and it won’t be good for HME providers.
Most respondents already serve patients with MA plans (84%) and expect their percentage of patients who have these plans to increase this year (59%). The problem: They experience more challenges serving...
In brief: Medicare spending, OIG savings, telehealth flexibility, cath reviews
December 11, 2024HME News Staff
WASHINGTON – Medicare spent 27% more, on average, for people who were covered by traditional Medicare after disenrolling from Medicare Advantage than for people who were continuously covered by traditional Medicare, after adjusting for differences in health status and other characteristics, according to a new analysis by the Kaiser Family Foundation.
This is a difference of $2,585 in Medicare spending per person, on average, between the two groups in 2022.
Other highlights...
New KFF analysis examines spending for traditional Medicare, MA
December 9, 2024HME News Staff
WASHINGTON – Medicare spent 27% more, on average, for people who were covered by traditional Medicare after disenrolling from Medicare Advantage than for people who were continuously covered by traditional Medicare, after adjusting for differences in health status and other characteristics, according to a new analysis by the Kaiser Family Foundation.
This is a difference of $2,585 in Medicare spending per person, on average, between the two groups in 2022.
Other highlights...
In brief: Reimbursement relief, MA guardrails, Numotion pilot
December 6, 2024HME News Staff
WASHINGTON – More than 30 leading patient advocacy organizations have weighed in with congressional leadership to support including provisions from H.R. 5555 and S. 1294 in any legislative package that moves before the end of the year, AAHomecare reports.
In a Dec. 2 letter from the ITEM Coalition, the groups assert that the expiration of 75/25 blended Medicare reimbursement rates on Jan. 1, 2024, has resulted in a “crushing blow to DMEPOS suppliers and providers, threatening...
Proposed rule would establish more guardrails for Medicare Advantage
December 4, 2024HME News Staff
WASHINGTON – CMS is proposing changes to the Medicare Advantage (MA) and Medicare Part D prescription drug programs to hold them more accountable for delivering high-quality care for people with Medicare.
In the Contract Year 2026 MA and Part D proposed rule, CMS proposes addressing inappropriate use of prior authorization and internal coverage criteria, including by defining the meaning of “internal coverage criteria” to clarify when MA plans can apply utilization management,...
Industry’s post-election mindset: ‘All we can do is be prepared’
November 15, 2024Theresa Flaherty, Managing Editor
WASHINGTON – How the HME industry’s legislative efforts fare in a post-election Congress will depend a lot on whether president-elect Donald Trump and his supporters want to “clear the decks,” say industry stakeholders.
From meetings on Capitol Hill last week, Jay Witter says committees in both the Senate and House of Representatives are preparing for an end-of-year package but are waiting for a signal as to whether that gets done this year or kicked to next year.
“All...
UHC delays Synapse arrangement
July 22, 2024HME News Staff
MINNEAPOLIS – UnitedHealthcare recently notified HME providers that it is delaying the implementation of its new capitated arrangement with Synapse Health for standard DME in Georgia and North Carolina, AAHomecare has reported.
The arrangement, which impacts the insurer’s Medicare Advantage plan members enrolled in HMO and PPO plans in the two states, will now go into effect Sept. 1 instead of Aug. 1 to allow more time for providers to familiarize themselves with new processes...
Making them nervous
July 16, 2024Liz Beaulieu, Editor
HME stakeholders have been fighting Medicare Advantage for some time, particularly when it comes to these plans not following Medicare policy and coverage for complex rehab technology and non-invasive ventilators, two product categories for patients with the greatest needs.
At the Heartland Conference in June, there was even a panel discussion titled “Dealing with Medicare DISadvantage Plans - Are You Ready, Martha?”
Stakeholders continue to take it up a notch.
AAHomecare...
Industry keeps heat on Medicare Advantage
July 3, 2024Theresa Flaherty, Managing Editor
YARMOUTH, Maine – There’s a lot of noise right now around improving the prior authorization process for Medicare Advantage plans and the HME industry needs to make sure it continues to add its voice to the conversation, say stakeholders.
Most recently, in June, members of the House of Representatives and the Senate reintroduced bipartisan legislation to streamline and standardize the use of prior authorization for these plans. The Improving Seniors’ Timely Access to Care...
Newspoll: When it comes to revenue, many providers seeing red
June 21, 2024Theresa Flaherty, Managing Editor
YARMOUTH, Maine – June marks the midpoint of the calendar year and so far, it’s been a financial disappointment, say 65% of respondents to a recent HME Newspoll.
“2024 has been a challenging year,” wrote one poll respondent. “Despite our growth in volume and workforce, we have encountered significant obstacles. We have faced difficulties in contracting, with closed insurance panels, struggled with low reimbursement rates, and dealt with high equipment costs.”
Reimbursement...