Medicare Advantage

Justice Department investigating Humana billing practices

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Humana Inc. reports that it is cooperating with a Department of Justice inquiry into whether it exaggerated the severity of elderly patients' illnesses to generate higher Medicare reimbursements.

Understanding consumer choice

Understanding consumer choice

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If you operate a senior living facility, here is something to put at the very top of your to-do list: Survey your residents to understand the choices they have made in the Medicare open enrollment period, which is closing tomorrow.

Medicare Advantage funding could be cut

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Supporters of Medicare Advantage program are roundly criticizing President Obama's fiscal 2016 budget plan to slash more than $36 billion in its funding over the coming decade.

Also in the news for Sept. 19, 2014

Americans are the most worried about losing their eyesight as they age, poll says .... AHCA says MedPAC Chairman is 'spot-on' with three-day stay comments ... Medicare Advantage enrollment rises for fifth straight year, CMS says.

Medicare Advantage organizations are unresponsive to provider questions, long-term care professionals tell CMS

Medicare Advantage organizations are unresponsive to provider questions, long-term care professionals tell CMS

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Several skilled nursing facility workers expressed frustration regarding communications with Medicare Advantage organizations during a public call with government officials Wednesday. Centers for Medicare & Medicaid Services representatives acknowledged that provider frustration in this area has been an ongoing issue, but they said that their hands essentially are tied.

CMS to hold Medicare Advantage conference

The Centers for Medicare & Medicaid Services will hold its Medicare Advantage & Prescription Drug Oversight & Enforcement 2014 Program Audits conference on Tuesday, June 24 .It is designed to "provide insight into how MA and Part D organizations can best prepare for a CMS performance audit." Participants can attend in-person or virtually.

Coordinated care programs: A lifeline for patients and your facility

Coordinated care programs: A lifeline for patients and your facility

If you serve elderly populations in a long-term care or nursing facility, you have my respect — for the compassion you bring to work each day and the challenges you must face.

CCRCs need to check residents' health insurance plans twice a year, expert urges

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Continuing care retirement communities should ask residents about their health plans twice a year, to keep tabs on the increasing number of seniors being shifted into Medicare Advantage, an expert told an audience of long-term care professionals in Chicago Wednesday.

Final rate notice signals continued pressure on Medicare Advantage payments

Final rate notice signals continued pressure on Medicare Advantage payments

CMS recently finalized Medicare Advantage plan payment rates for Calendar Year 2015 and announced other changes to payment and program policies for MA and Part D plans. Although the announcement included some positive changes for plans, the overall impact is mostly negative.

Government would pay seniors to create advanced directives under Senate bill

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Medicare beneficiaries would be paid to create advance directives and store them in an easy-access system if a recently proposed Senate bill were to become law.

MedPAC endorses readmissions penalties for home health, hospice benefit for Medicare Advantage

MedPAC endorses readmissions penalties for home health, hospice benefit for Medicare Advantage

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Home health providers should be subject to Medicare reimbursement penalties based on hospital readmission rates, according to the Medicare Payment Advisory Commission.

Jimmo correction: Assistants may provide maintenance services in skilled nursing facilities

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Skilled nursing facilities may be reimbursed for maintenance therapy services performed by assistants, the Centers for Medicare & Medicaid Services clarified in a recent Medicare Benefit Policy manual revision. CMS officials announced and explained the revision in an Open Door Forum call Thursday.

The ACA's 'comprehensive' long-term care failure

The ACA's 'comprehensive' long-term care failure

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There's been a lot of talk lately about what constitutes "comprehensive" health insurance coverage — and long-term care notably has not been part of this national conversation.

I pay dead people

I pay dead people

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On Oct. 31 (an ironic coincidence?) a report from the Office of inspector General frighteningly said Medicare paid some $23 million in benefits for more than 17,000 dead people in 2011. And my husband says I waste money.

Premera Blue Cross will enter Medicare Advantage market

Washington-based Premera Blue Cross will enter the Medicare Advantage market in 2014, the company announced Oct. 1.

Fewer Medicare Advantage plans in 2014, analysis finds

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There will be fewer Medicare Advantage plans in 2014, according to a new analysis. The number of plans will drop to 2,522, which is around a 5% decrease, according to Avalere Health. Medicare Advantage can cover skilled nursing stays, and enrollment was up in 2012.

MedPAC calls for permanent reauthorization of Medicare Advantage plan covering nursing home residents

MedPAC calls for permanent reauthorization of Medicare Advantage plan covering nursing home residents

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The Medicare Advantage special needs plan that enrolls nursing home residents, set to expire at the end of 2014, will be permanently reauthorized if Congress acts on recommendations proposed by the Medicare Payment Advisory Commission (MedPAC).

Fraud-fighting efforts not much to brag about

Fraud-fighting efforts not much to brag about

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In what has become a frequent event, the Inspector General at the Department of Health and Human Services has just issued yet another report that crows about heroic fraud-fighting efforts.

CMS nudges beneficiaries away from low-performing MA plans

CMS nudges beneficiaries away from low-performing MA plans

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The Centers for Medicare & Medicaid Services is encouraging around 375,00 Medicare Advantage members to re-evaluate their plans.

Administration proposal would ease Medicare coverage for SNF stays

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Federal health officials have agreed to changes in Medicare coverage rules that would make it easier for beneficiaries with chronic conditions to qualify for nursing home stays, outpatient therapy and home healthcare services, according to reports.

House committee subpoenas HHS over Medicare Advantage demonstration project

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Rep. Darrell Issa (R-CA) and other House Republicans issued a subpoena Monday to gain access to documents related to an Affordable Care Act Medicare Advantage demonstration project.

Affordable Care Act will reduce Medicare Advantage overpayments by $132 billion, Commonwealth Fund report finds

Affordable Care Act will reduce Medicare Advantage overpayments by $132 billion, Commonwealth Fund report finds

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Affordable Care Act reforms to Medicare Advantage (MA) will save the federal government $132 billion over 10 years, a new analysis has found.

Medicare premiums would rise for most beneficiaries under a premium-support model, study says

Medicare premiums would rise for most beneficiaries under a premium-support model, study says

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Under a premium-support model for Medicare, six in 10 beneficiaries would see an increase in their premiums, a non-partisan study released Monday found.

HHS: Medicare Advantage enrollment is up, premiums down

HHS: Medicare Advantage enrollment is up, premiums down

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Enrollment in Medicare Advantage has jumped by 28% since the Affordable Care Act was enacted in 2010, federal health officials said Wednesday.

House members raise concerns over Medicare Advantage demonstration project

House members raise concerns over Medicare Advantage demonstration project

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Republican members of the House Ways and Means Committee have accused the Department of Health and Human Services of overstepping its authority in implementing a controversial Medicare Advantage demonstration project.

Government expenditures for possibly duplicative healthcare services is growing, analysis finds

The federal government increasingly has spent potentially duplicative funds on individuals receiving healthcare benefits through the Veterans Administration and Medicare Advantage, a new analysis finds.

Reports forecast Medicare funding boost, dim overall outlook

Reports forecast Medicare funding boost, dim overall outlook

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The Affordable Care Act will help Medicare save over $200 billion through 2016, according to government actuaries. But questions as to Medicare's long-term solvency remain, another report from Social Security and Medicare Boards of Trustees states.

Low-quality Medicare Advantage plans should expect scrutiny, CMS says

Low-quality Medicare Advantage plans should expect scrutiny, CMS says

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Medicare Advantage plans with fewer than five stars on the quality scale should expect some form of audit, a Centers for Medicare & Medicaid official said this week.

Troubling steps ahead for Nursing Home Compare?

Troubling steps ahead for Nursing Home Compare?

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A newly announced plan to mine data from Medicare Advantage plans might give many operators an unexpected spine shiver.

Report: Improper Medicare Advantage payments fell $1.2 billion in 2011

Report: Improper Medicare Advantage payments fell $1.2 billion in 2011

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Recovery audit contractors and other quality assurance efforts allowed Medicare Advantage to reduce improper payments by $1.2 billion in 2011, according to a new government report.