Commercial Insurer Accountability
The ºÚÁÏÕýÄÜÁ¿ Association is deeply concerned that these practices will result in the maintenance of the status quo where MAOs apply their own coverage criteria that is more restrictive than Traditional Medicare proliferating the very behavior that CMS sought to address in the final rule,…
Health Plan Accountability Update, November 2023.
Payment denials by Medicare Advantage plans jumped 56% for the median health system between January 2022 and June 2023, contributing to a 28% decline in median cash reserves, according to the latest analysis of data from over 1,300 hospitals and health systems by Syntellis Performance Solutions and…
On November 15th, The ºÚÁÏÕýÄÜÁ¿ Association and a panel of experts from member hospitals and health systems discussed recent changes to the Medicare Advantage program that were finalized by the Centers for Medicare & Medicaid Services earlier this year. With new rules having gone…
On April 5, the Centers for Medicare & Medicaid Services (CMS) finalized its Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Program for contract year (CY) 2024. The final rule increases oversight of Medicare Advantage (MA) plans and seeks to better…
The Centers for Medicare & Medicaid Services (CMS) Nov. 6 released its proposed Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly, and Health Information…
The Centers for Medicare & Medicaid Services Nov. 6 proposed changes to the Medicare Advantage and prescription drug programs for contract year 2025 intended to improve access to behavioral health care; ensure that agents and brokers enroll individuals in the best plan for their needs and that…
Over 30 members of the House of Representatives Nov. 3 urged the Centers for Medicare & Medicaid Services to monitor and evaluate how Medicare Advantage plans use artificial intelligence and algorithms to guide their coverage decisions, and ensure these tools comply with Medicare rules and do…
Trends in health insurance coverage are driving an increase in medical debt: these include inadequate enrollment in comprehensive health care coverage, growth in high-deductible and skinny health plans that intentionally push more costs onto patients, and misleading health plan practices that…
AHA on Oct. 19 submitted a statement to the House Energy and Commerce Health Subcommittee on legislative proposals involving Medicare.