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Payment Rates

All articles tagged with #payment rates

healthcare2 years ago

The Growing Divide: Seniors Embrace Medicare Advantage, While Hospitals and Doctors Remain Skeptical

Health care providers, including hospitals and doctors, are increasingly refusing to accept Medicare Advantage plans, despite the growing popularity of these plans among Medicare beneficiaries. The friction between insurers and providers arises from payment rates imposed by Medicare Advantage plans and the perceived burdensome requirements for preapproval and claims denials. Patients may be forced to switch plans or revert to traditional Medicare, which can be challenging. The conflicts between insurers and providers may be the beginning of a trend as the Medicare market becomes more concentrated among a few insurers. Studies show that Medicare Advantage costs taxpayers more per beneficiary than the traditional program, but the plans enjoy political support due to their popularity.

healthcare2 years ago

CMS Finalizes Increased Medicare Home Health Payments for CY 2024

The Centers for Medicare & Medicaid Services (CMS) has issued the calendar year (CY) 2024 Home Health Prospective Payment System (HH PPS) Rate Update final rule, which updates Medicare payment policies and rates for Home Health Agencies (HHAs). The rule includes routine updates to the Medicare Home Health PPS payment rates for CY 2024, resulting in an estimated 0.8 percent increase in Medicare payments to HHAs compared to CY 2023. The rule also includes adjustments related to the implementation of the Patient-Driven Groupings Model (PDGM), rebasing and revising the home health market basket, and the establishment of regulations for lymphedema compression treatment items and home intravenous immune globulin (IVIG). Additionally, the rule includes enrollment provisions for hospices and the implementation of a special focus program (SFP) to enhance oversight of poor-performing hospices.

healthcare2 years ago

Medicare Advantage Rates and Reforms: Latest Updates.

The Centers for Medicare & Medicaid Services (CMS) has finalized a 3.3% increase in payment rates for Medicare Advantage plans for 2024, which is higher than the 1.1% hike proposed in February. The revised rates will result in a $13.8B increase in payments for MA plans next year. Health insurers operating in the MA market include Humana, Centene, UnitedHealth, CVS Health, Cigna, Elevance, Clover Health, and Alignment Healthcare. CMS also announced the recoupment of overpayments made to Medicare Advantage plans starting this year to protect the fiscal sustainability of Medicare.