I. MEDICALLY NECESSARY ORAL HEALTH COVERAGE IN MEDICARE The 2024 Medicare Physician Fee Schedule (PFS) proposed rule released recently includes a proposal to clarify reimbursement for dental services necessary to the clinical … [Read more...] about Issue Brief 81 | August 2023 – Medicare Oral Health Updates & Other Issues
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Issue Brief 80 | May 2023 – Final Part C & D Rule, and Other Issues
I. FINAL PART C & D RULE On April 12, 2023, the Centers for Medicare and Medicaid Services (CMS) published a final rule for 2024 regarding Medicare Advantage (MA) and Part D. The final rule is available in the Federal Register at 88 Fed … [Read more...] about Issue Brief 80 | May 2023 – Final Part C & D Rule, and Other Issues
Nursing Homes Operate Managed Care Programs for Their Residents – A Conflict of Interest
Although skilled nursing facility owners and operators complain about Medicare Advantage (MA) plans because they pay lower daily Medicare rates for shorter period of time than the traditional Medicare program,[1] they increasingly see a financial … [Read more...] about Nursing Homes Operate Managed Care Programs for Their Residents – A Conflict of Interest
Barriers to Care for Medicare Advantage Enrollees Highlighted even as Insurance Industry Continues Effort to Retain Their Overpayments
As the Center for Medicare Advocacy has outlined in recent CMA Alerts (including here, here and here), the Centers for Medicare & Medicaid Services (CMS) has recently taken long overdue steps to address Medicare Advantage (MA) overpayments and … [Read more...] about Barriers to Care for Medicare Advantage Enrollees Highlighted even as Insurance Industry Continues Effort to Retain Their Overpayments
Insurance Industry Response to Proposed Medicare Advantage Payment for 2024
“Our Profits are The Sky is Falling!” This is the time of year – between the Centers for Medicare & Medicaid Services’ (CMS) release of proposed Medicare Advantage (MA) payment rates for the following year and the finalization of these … [Read more...] about Insurance Industry Response to Proposed Medicare Advantage Payment for 2024
Gaps in Hospice Abuse and Neglect Reporting
The U.S. Government Accountability Office (GAO) recently reviewed requirements for reporting abuse and neglect allegations to the Centers for Medicare & Medicaid Services (CMS). GAO concluded gaps existed in requirements for hospices as compared … [Read more...] about Gaps in Hospice Abuse and Neglect Reporting
Senate Report Highlights Widespread Medicare Advantage Marketing Misconduct – But the Driving Forces of Misconduct Are Broader
After the Centers for Medicare & Medicaid Services (CMS) reported earlier this year that Medicare beneficiary complaints about Medicare Advantage (MA) marketing more than doubled between 2020 and 2021, the Senate Finance Committee launched an … [Read more...] about Senate Report Highlights Widespread Medicare Advantage Marketing Misconduct – But the Driving Forces of Misconduct Are Broader
Issue Brief 77, October 2022 | Home Health Updates & Other Issues
HOME HEALTH UPDATE Center for Medicare Advocacy Sues on Behalf of Medicare Beneficiaries Seeking Fair Access to Home Health Care After years of fruitless efforts to ensure Medicare beneficiaries can receive Medicare-covered home health care … [Read more...] about Issue Brief 77, October 2022 | Home Health Updates & Other Issues
Center Comments on Medically Necessary Oral Health Coverage
The following is an excerpt from our full comments on the 2022 Physician's Fee Schedule. II.L. Proposals and Request for Information on Medicare Parts A and B Payment for Dental Services I. … [Read more...] about Center Comments on Medically Necessary Oral Health Coverage
Issue Brief #76 – August 2022 – Medicare Provisions in the Inflation Reduction Act & Other Issues
1. MEDICARE PROVISIONS in the INFLATION REDUCTION ACT of 2022 (IRA) On Tuesday, August 16, 2022, President Biden signed into law the Inflation Reduction Act (IRA) of 2022 (Pub Law 117-169), which includes expansive health and climate … [Read more...] about Issue Brief #76 – August 2022 – Medicare Provisions in the Inflation Reduction Act & Other Issues