Healthcare systems have found themselves in precarious financial standing due to a dramatic increase in the number of inpatient claims being denied by health insurers based on the lack of medical necessity, according to data collected by accounting and technology firm Crowe. These level-of-care reimbursement disputes are especially rising in frequency among Medicare Advantage
Value-based Medicare Advantage models see better outcomes and better efficiency for patients, both in general and across specific metrics such as avoidable emergency department visits and readmissions, according to a new study commissioned by Optum and published in JAMA Network. Patients in such models were 18% less likely to be admitted to the hospital and had a 9% lower
Insurers and the administration are battling over whether Medicare Advantage plans are getting a payment increase or decrease in 2024. On February 1, the Centers for Medicare and Medicaid Services released the 2024 Advance Notice for the Medicare Advantage and Part D Prescription Drug Programs in which CMS said MA plans are expected to receive a 1.03% increase in revenue.
The Centers for Medicare and Medicaid Services (CMS) published its final rule regarding the Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program in early February.
In the final rule, CMS announces that it will recover excess premiums paid to MA plans when it finds unsupported or inaccurate plan-submitted risk adjustment data.