Centers for Medicare & Medicaid ServicesDepartment of Health and Human Services June 5, 2023 Re: Medicare and Medicaid Programs; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality … [Read more...] about Center Comments on Skilled Nursing Facilities Payments and Oversight, 2023
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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
Kaiser Family Foundation Releases Report Regarding Differences Between Traditional Medicare and Medicare Advantage
On September 16, 2022, the Kaiser Family Foundation (KFF) released a report titled Beneficiary Experience, Affordability, Utilization, and Quality in Medicare Advantage and Traditional Medicare: A Review of the Literature. The report reviewed … [Read more...] about Kaiser Family Foundation Releases Report Regarding Differences Between Traditional Medicare and Medicare Advantage
Office of Inspector General (OIG) Issues Another Report Highlighting Inappropriate Medicare Advantage Denials
Prior Authorization as a Barrier to Care Prior authorization and other utilization management tools can serve as significant barriers to care that both current and prospective Medicare Advantage enrollees are often unaware of until they need to … [Read more...] about Office of Inspector General (OIG) Issues Another Report Highlighting Inappropriate Medicare Advantage Denials
Insurance Industry v. Provider Response to OIG Report re: MA Denials
The recently issued HHS Office of Inspector General report focusing on Medicare Advantage plan denials titled “Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary … [Read more...] about Insurance Industry v. Provider Response to OIG Report re: MA Denials
OIG Report Estimates of Inappropriate MA Plan Denials May be Understated
The recently issued HHS Office of Inspector General (OIG) report focusing on Medicare Advantage plan denials titled “Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically … [Read more...] about OIG Report Estimates of Inappropriate MA Plan Denials May be Understated
CMA Alert | February 10, 2022
It’s Time: Repeal the 3-Day Inpatient Hospital Requirement for Medicare Skilled Nursing Facility Coverage Last year, the Center for Medicare Advocacy suggested that it was time to repeal the three-day inpatient hospital requirement that is … [Read more...] about CMA Alert | February 10, 2022
CMA Alert | January 13, 2022
CMS Releases Proposed 2023 Rule for Medicare Advantage and Part D Plans On January 6, 2022, CMS released CY 2023 Medicare Advantage and Part D Proposed Rule (CMS-4192-P) and an accompanying Press Release describing the overall rule, and a separate … [Read more...] about CMA Alert | January 13, 2022
Jimmo Update: CMS Reminds Providers and Contractors of Medicare Coverage to Maintain or Slow Decline
Skilled nursing care and skilled therapy services for beneficiaries who need skilled care to maintain function or to prevent or slow decline is covered by Medicare. That is the message of reminders issued by the Centers for Medicare & Medicaid … [Read more...] about Jimmo Update: CMS Reminds Providers and Contractors of Medicare Coverage to Maintain or Slow Decline
Issue Brief – January 2022 – Home Health Survey Report and Other Issues
FEDERAL UPDATE Medicare and Build Back Better During the last Alliance webinar in November 2021, we discussed the legislative package Congress was debating called the Build Back Better Act (BBB) that was to be passed through the … [Read more...] about Issue Brief – January 2022 – Home Health Survey Report and Other Issues