Tag Archives: medicare advantage

Billing No-Nos: Having the Billing Dept. Transact MA Encounters

Medicare Advantage (MA) plans are paid by the Centers for Medicare and Medicaid Services (CMS) based on the member’s severity of illness as conveyed by codes from the International Classification of Diseases, 10th Revision or ICD-10-CM that map to the … Read Full Post

Tagged FFS, medical billing, medicare advantage, risk adjusted payment |

WWR – Kaiser agrees to pay $6.4 million to settle claims it received inflated Medicare Advantage payments

Kaiser joins the undignified ranks of the companies investigated for committing fraud. This timely article from Healthcare Finance News doesn’t use that word, but it describes the finding that Kaiser “knowingly submitted” false diagnoses to inflate its payments, which is … Read Full Post

Tagged coding compliance, medicare advantage, medicare risk adjustment, mra, risk adjusted reimbursement |

President’s Order to Protect and Improve Medicare

President Trump signed an Executive Order on October 3, 2020 aimed at protecting and improving the Medicare program. The Order outlines steps to improve fiscal sustainability of the Medicare program and plans to increase choices, flexibility and value. Below is … Read Full Post

Tagged cms, MA plans, medicare, medicare advantage, protect Medicare |

What We’re Reading – Walmart partners with Clover Health to offer Medicare Advantage plans

It was just a matter of time before more players entered the healthcare space, which has been front & center for some time, but it’s interesting to see a retail giant take steps to become an insurer. Beginning next year, … Read Full Post

Tagged health insurance, medicare advantage, PPO, Walmart |

What We’re Reading – New CMS Data Highlights ‘Massive’ Expansion of Home Care-Related Medicare Advantage Benefits

CMS announced significant positive changes for 2021 Medicare Advantage (MA) plans, two of which are quite impactful for the home health industry. Supplemental MA benefits will be offered by more plans in 2021. This article covers the two broad categories … Read Full Post

Tagged cms, home health, in-home services, MA plan, medicare advantage, special supplemental benefits for the chronically ill, SSBCI |

CMS Announced Significant Added MA Benefits for 2021

CMS announced numerous significant changes for Medicare Advantage (MA) plans that will positively impact members in 2021: MA membership is projected to be at an all-time high of 26.9 million, compared to 24.4 million in 2020. In 2021, beneficiaries with … Read Full Post

Tagged cms, insulin, MA plan, MA premiums, medicare advantage, supplemental benefits, telehealth |

ESRD Patients Can Join Medicare Advantage Plans in 2021

As we may know, patients with end stage renal disease (ESRD) have, historically, not been allowed to enroll in Medicare Advantage plans. About 130,000 were grandfathered in through employer-sponsored coverage or developed it after enrolling in MA plans. That will … Read Full Post

Tagged dialysis, end stage renal disease, ESRD, kidney disease, MA plans, medicare advantage, mra |

CMS is holding some provider payments

The Centers for Medicare & Medicaid Services (CMS) has identified technical issues with certain parts of the April 2013 quarterly systems release. For claims with dates of service or “through dates” on or after April 1, 2013, the issues affect … Read Full Post

Tagged ambulatory surgical center claims, center for medicare and medicaid services, home health billing, home health claims, homecare billing, Imark consulting, indirect medical education, inpatient prospective payment system, medicare advantage, medicare advantage inpatient prospective payment system, outpatient critical access hospital, rural health clinic |

Medicare ACOs: Stroke of Genius or Mathematical Impossibility? (Part 1)

The big buzz these days is about ACOs. In this series, we will discuss some of the features of Accountable Care Organizations and explore the overall question: Are Medicare ACOs a stroke of genius or a mathematical impossibility? This five-part … Read Full Post

Tagged accountable care organizations, background of medicare acos, fee-for-service, health care system, ma mso or ipa, medicare acos, medicare advantage, medicares shared savings program, physician groups |