Tag: Medicare Advantage
AAH, ALS association send NIV letter to CMS
October 12, 2023HME News Staff
WASHINGTON – AAHomecare and the ALS Association continue to press their case with CMS that Medicare Advantage plans are improperly denying claims and imposing stricter coverage criteria for non-invasive ventilators than Medicare allows.
In an Oct. 4 letter to Kathryn Coleman, director, Medicare Drug & Health Plan Contract Admin Group for CMS, AAHomecare and the ALS Association share examples of MA plans that are “ignoring physician's orders and instead use excessive prior...
Cigna pays $172M to resolve FCA allegations
October 4, 2023HME News Staff
PHILADELPHIA – Cigna has agreed to pay $172 million to resolve allegations that it violated the civil False Claims Act by submitting and failing to withdraw inaccurate and untruthful diagnosis codes for its Medicare Advantage Plan enrollees to increase its payments from Medicare.
Cigna will pay about $135 million to resolve the allegations, with the remaining $37 million resolving allegations related to unsupported diagnoses for MA beneficiaries arising from Cigna’s home visit...
In brief: Philips refutes claims, MA premiums remain stable, NCPA supports CVS lawsuitÂ
September 29, 2023HME News Staff
AMSTERDAM – Philips disagrees with “characterizations” in recent articles that the company knew for several years about problems with certain ventilators and sleep apnea devices.
ProPublica and the Pittsburgh Post-Gazette on Sept. 27 published an article saying that Philips knew about a dangerous breakdown inside its widely used ventilators and sleep apnea machines but waited years before recalling the devices in 2021.
In a statement, Philips said it had previously...
CMS: Medicare Advantage, drug programs to remain stable in 2024Â
September 27, 2023HME News Staff
WASHINGTON – Average premiums, benefits and plan choices for Medicare Advantage and the Medicare Part D prescription drug program will remain stable in 2024, according to CMS.
The announcement precedes the upcoming Medicare Open Enrollment period, which begins Oct. 15, 2023, to help people with Medicare determine the best Medicare coverage option for their health care needs.
“A top priority for CMS is to protect and strengthen the Medicare program for people with Medicare,...
Andrea Stark on re-engineering Medicare Advantage
September 8, 2023Liz Beaulieu, Editor
YARMOUTH, Maine – There will be overdue changes to Medicare Advantage in the next year that will make them “a lot more friendly” to HME providers, says Andrea Stark.
Stark, a Medicare consultant and reimbursement specialist with MiraVista, joined the HME News in 10 podcast in August to take a deep dive into the “state of the state” of Medicare Advantage and what’s in store for these plans.
Here’s an excerpt:
‘State of the...
Stakeholders push back against vent denial ratesÂ
August 15, 2023Theresa Flaherty, Managing Editor
WASHINGTON – With an “absurd” denial rate as high as 86% for non-invasive ventilators for one major Medicare Advantage plan, industry stakeholders are collaborating with patient advocacy groups to elevate their concerns with CMS.
Confusion around who qualifies for NIVs vs. bi-level devices is nothing new, but recently, it’s gotten worse, says David Chandler, senior director of payer relations for AAHomecare.
“It’s escalated to what I consider...
VGM seeks to streamline MA complaint processÂ
June 26, 2023HME News Staff
WATERLOO, Iowa – VGM & Associates encourages providers to supply the Office for Program Operations and Local Enforcement at CMS with examples of Medicare Advantage organizations denying prior authorizations and claims for several important categories of DME. “We understand the urgency surrounding these issues and have been talking with them about the best process to resolve them,” VGM stated in a recent bulletin. “In addition to those efforts, several of our members have asked...
In brief: MA reform, Invacare credit, health expendituresÂ
June 21, 2023HME News Staff
LOS ANGELES – A new analysis by researchers at the University of Southern California warns that overpayments to Medicare Advantage plans now exceed 20%, or $75 billion annually, underscoring the urgent need for reform.
Researchers with the USC Schaeffer Center for Health Policy & Economics found that the millions of beneficiaries in traditional Medicare who have switched to Medicare Advantage plans have lower spending than those with similar health risks. They report this pattern of...
Hunger Games? Used car market, Medicare Advantage both tough markets
June 19, 2023Theresa Flaherty, Managing Editor
I am currently in the market for a new used car, my first in 10 years. While I knew it was coming, the news came as an unwelcome shock because I, too, have heard about the vehicle shortages, high costs and high interest rates that have turned what was already an unpleasant experience, at best, into a Hunger Games-style free-for-all.
Over at my work desk, the big news is the Humana contracts, an exciting opportunity for AdaptHealth and Rotech and a source of dread and anxiety for everyone else...
Researchers call for Medicare Advantage reformÂ
June 19, 2023HME News Staff
LOS ANGELES – A new analysis by researchers at the University of Southern California warns that overpayments to Medicare Advantage plans now exceed 20%, or $75 billion annually, underscoring the urgent need for reform.
Researchers with the USC Schaeffer Center for Health Policy & Economics found that the millions of beneficiaries in traditional Medicare who have switched to Medicare Advantage plans have lower spending than those with similar health risks. They report this pattern of...