May 22, 2020
By Mark Spivey CMS Continuing Telehealth Push in Announcing Changes for Part D and Medicare Advantage Beneficiaries
The changes will be applicable to some 67 million enrollees. The approximately 67 million Americans with either Medicare Advantage (MA) or Medicare Part D health plans will enjoy more benefits and options following the implementation of changes federal officials announced just prior to the start of Memorial Day weekend.…
By Marvin D Mitchell, RN, BSN, MBA
This decision applies only to those whose stay was changed to observation after inpatient admission. In a decision released on March 24, a judge of the U.S. District Court for the District of Connecticut released a memorandum of decision in the case of Alexander v. Azar, creating new appeal rights…
January 9, 2020
By Chuck Buck CMS Releases New MOON, Important Message from Medicare, and Detailed Notice of Discharge
Same old New MOON, but potential problems appear in two of the other three new forms. All federal forms require periodic review and reapproval by the Office of Management and Budget (OMB). The approval is indicated on the form by a unique number and an expiration date. The Centers for…
By Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP
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
By Chuck Buck 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
By Mark Spivey 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
By Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP 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
By Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP 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
By Ronald Hirsch, MD 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
By Chuck Buck 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…
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