The Centers for Medicare & Medicaid Services raised eyebrows when it proposed lower Medicare Advantage reimbursement rates for 2016, but the proposal isn't all bad news for Medicare Advantage plans.
The Department of Justice has requested information from Humana regarding risk adjustments assigned to Medicare Advantage beneficiaries, according to an annual report the insurance company filed to the Securities and Exchange Commission.
The Centers for Medicare & Medicaid Services claim that its proposal to cut Medicare Advantage reimbursement rates by 0.95 percent in 2016 will not impact insurers' revenue, but industry experts say the changes will hit their bottom lines.
The Centers for Medicare & Medicaid Services has proposed a 0.95 percent decrease in Medicare Advantage reimbursement rates for 2016. However, risk-scoring adjustments should give payers a 1.05 percent increase in total revenue, CMS said.
In what is believed to be the first case of its kind in South Florida, prosecutors are pursuing criminal fraud charges against a physician that overcharged Medicare Advantage plans. The case has pulled the health plan into the spotlight as it attempts to stave off spending cuts.
The healthcare industry continues to evolve in the post-Affordable Care Act market. A new Avalere Health report has summarized four key trends that will impact insurers this year as they update their business models to remain profitable and competitive.
Medicare Advantage is an increasingly popular choice among eligible consumers--including those who are already enrolled in traditional Medicare. In fact, at least half of new Medicare Advantage enrollees switched from Medicare each year.
Insurers are readying efforts to fight back against another round of Medicare Advantage cuts that are expected to come next month. But the campaign to keep Medicare Advantage payments stable may be harder than last year due to the post-midterm election political environment.
If Medicare Advantage plans drop significant amount of providers from their networks, their affected members can leave those plans and enroll instead in traditional Medicare.
Back in 2009, the Congressional Budget Office predicted that Medicare spending would be $706 billion in 2014. But spending will end up amounting to $580 billion. A number of factors contributed to this $126 billion gap, according to a new analysis from the Kaiser Family Foundation.