Medicare Advantage plans have reacted to industry criticism of their limited coverage expansion of SdoH. I expected a buzz over our recent Monitor Mondays report and RACmonitor article about the limited coverage expansion of the social determinants of health (SDoH) by Medicare Advantage (MA) plans. Actually, there have been a…
October 10, 2019
Trump’s Executive Order Appears to Favor Medicare Advantage Plans over Medicare FFS
Physicians are sure to bristle at a perceived push toward non-physician practitioners operating more independently. EDITOR’S NOTE: President Donald Trump last Thursday signed an executive order tweaking the Medicare system during a campaign-style rally at The Villages, a Florida retirement community. In reporting on last week’s executive order signed by…
October 3, 2019
Kaiser Health News sues CMS, HHS over denial of access to Medicare Advantage audit info
The nonprofit news service alleges the federal government violated the Freedom of Information Act by refusing to disclose documents reflecting risk adjustment validation data. Kaiser Health News (KHN) has filed a federal lawsuit against the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human…
September 25, 2019
Industry Research Says Providers, Plans Not Doing Enough to Address the SDoH
Two recent studies indicate more can be done by providers and payers. The healthcare industry continues to devote ample attention to the social determinants of health (SDoH). A minimum of two studies on the topic appear weekly, each yielding the same compelling arguments: Healthcare organizations, providers, and stakeholders could do…
August 29, 2019
Mega Medicare Advantage Market Mandated For the SDoH
California-based Zing Health latest to join SDoH market of payers. Since 2018, there has been common language introduced by insurers that includes the verbiage “so-and-so is uniquely positioned to address the SDoH (social determinants of health),” all followed by, “with new programming” promising to: Enhance health outcomes; Be customized to…
August 1, 2019
How Patient Rights are Being Impacted by Medicare Advantage Plans’ Use of Long Observation Stays
Protecting patient rights is one of the cornerstones of Medicare policy. As a doctor, I can assure you that I would rather patients concentrate on their health and not worry about whether their medical providers or their insurers are making decisions for them based on considerations that are not in…
August 1, 2019
The Unfair Advantage of Medicare Advantage Plans
Medicare Advantage plans appear to be following their own rules. Many of the national Medicare Advantage (MA) plans are misusing commercial guidelines and making up their own rules, as they see fit, in order to avoid paying hospitals equitably for the care provided to their members. That was the assessment…
This case of goes beyond DSH payments. Earlier this month the U.S. Supreme Court decided an appeal brought by Allina and many other hospitals challenging the methodology the government used when calculating disproportionate share payments. But even if this sounds irrelevant, don’t stop reading, because this decision will have an…
June 6, 2019
MA Plan Denials: Is That Convoluted or What?
Medicare Advantage Plan contracts are “take-it-or-leave-it” agreements Many questions are swirling about regarding Medicare Advantage Plan (MAP) denials asking what to do about the increasing number and given reasons. I’ve heard or read some amazing stories where payers have gone to astounding lengths to deny claims. Answers are also swirling…
A Manhattan Institute senior fellow makes his case for Medicare Advantage. A prominent conservative healthcare policy expert had a simple message in a recent opinion column: before diving into a debate over the prospects of “Medicare for All,” maybe Medicare needs a bit of tinkering first. Manhattan Institute Senior Fellow…
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