A Look at How Medicare Advantage Affects Providers

June 6th, 2023|Categories: Featured, Industry News|Tags: , , , , |

Although Medicare Advantage (MA) has been greatly beneficial for participating payer organizations, the picture is less rosy for providers, according to an analysis from the Kaiser Family Foundation (KFF). Providers must deal with a more complex policy framework when working with MA plans, resulting in an increased administrative burden and higher costs.

Medicare Advantage Programs Not Helping with US Healthcare Spending

May 10th, 2023|Categories: Featured, Industry News|Tags: , , , |

Medicare Advantage is a program set up by the US federal government to allow private plans to provide government-funded healthcare services to older adults. Although the goal was to offset spending per Medicare beneficiary, it’s done the opposite, with Medicare Advantage plans often costing much more per member than Medicare Parts A and B.

CMS Issues Final Rule on Medicare Advantage Prior Authorization Requirements

May 8th, 2023|Categories: Featured, HEOR Feature, Industry News|Tags: , , , |

The US Centers for Medicare and Medicaid Services (CMS) has issued its final rule on prior authorization requirements for Medicare Advantage (MA) plans. The rule changes ensure that prior authorization approvals last as long as medically necessary, that plans must only use prior authorization policies to check diagnoses, and that plans must give beneficiaries a 90-day transition period when changing plans.

US CMS Passes Rule Targeting Misleading Ads for Medicare Advantage Programs

April 6th, 2023|Categories: Featured, Industry News|Tags: , , , , |

The US Centers for Medicare and Medicaid Services (CMS) has implemented a new rule to limit misleading advertisements for Medicare Advantage programs. The rule would ban companies from producing advertising that would lead consumers to believe they are official government messaging. In addition, it would force companies to name the specific plans in their advertising.

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