Medicare Advantage

Medicine to Feds: Back Off Prior Authorization Requirements - 08/09/2024

The Texas Medical Association, American Medical Association, and a host of other medical societies are trying to stop onerous, care-impeding prior authorization requirements from overrunning Medicare Advantage plans.

New Medicare Advantage Rules Aim to Improve Access, Equity - 05/15/2024

Medicare Advantage enrollees soon may benefit from expanded access to outpatient behavioral health care and more equitable prior authorization policies.

CMS Finalizes 2025 Medicare Advantage Payment Rates - 04/16/2024

Despite a 0.16% reduction in base pay rate, Medicare Advantage plans are projected to see a 3.7% growth in revenue in 2025 thanks to a rising average patient risk score.

Medicare Advantage – and Disadvantage: Program Enrollment Grows Amid Physician Concerns - 04/03/2024

Despite its growing popularity among Medicare patients, Medicare Advantage is divisive among physicians.

Medicare Advantage Plans Wrongly Denied Prior Auth, Payment Requests, Fed Report Shows - 05/06/2022

About 13% of prior authorization denials in Medicare Advantage likely prevented or delayed necessary care, according to an analysis by the U.S. Department of Health and Human Services Office of the Inspector General. The report also found that nearly one-fifth of the time Medicare Advantage plans denied payment requests when the request met Medicare coverage rules and should have earned approval.

Medicare Advantage Plans - 11/17/2020

More than ten million Medicare beneficiaries currently receive their Medicare coverage through Medicare Advantage (MA); a program in which Medicare contracts with and pays private health plans to provide coverage for Medicare benefits.

Anybody There? Physicians Unfairly Penalized for AWOL Medicare Advantage Patients - 09/04/2019

You’ve tried and tried and tried. Phone calls, emails – nothing. A Medicare Advantage plan assigned you a patient who didn’t choose you, and the patient is driving that point home – by ignoring you. Or maybe the contact information the plan gave you is out of date, and the patient’s latest phone number or email is unknown. Either way, your as-yet-unseen patient is AWOL – and you can be penalized for it on health plans’ quality ratings, which ultimately can affect payments. New Texas Medical Association policy takes aim at the unfairness this lack of patient response can present for physicians, while opening up an opportunity for medicine to work with health plans to solve the problem.

Help Your Medicare Patients Keep Their Favorite Doctor (You) - 11/28/2018

Medicare’s open enrollment runs through Dec. 7, and some of your patients might be evaluating their plan options. Do they know what plans you take?

TMA asks CMS to Prohibit Step Therapy in Medicare Advantage - 11/16/2018

Step therapy protocols “can both harm patients and undercut the physician-patient decisionmaking process,” the Texas Medical Association said in a letter urging the Centers for Medicare & Medicaid Services (CMS) to reconsider its recent decision to allow step therapy in Medicare Advantage plans.

Amerigroup to Conduct New Post-Payment Reviews - 05/30/2018

Amerigroup has begun conducting post-payment reviews of certain claims billed with modifiers for distinct procedural services. The reviews apply only to Medicare Advantage and Medicare supplement professional claims.