Fee for Service Reimbursement

OIG Strengthens Oversight Strategy for Managed Care Organizations

August 30, 2023 - Managed care organizations (MCOs) require the same kind of oversight that fee-for-service programs receive from the Office of Inspector General (OIG), so OIG released a four-phase life cycle to align its oversight efforts. A growing number of enrollees are covered through MCOs. Over eight in ten Medicaid beneficiaries have coverage through MCOs for...

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Value-Based Care and Fee-For-Service: What’s the Difference?

by Victoria Bailey

In an effort to improve care quality and lower costs, the healthcare industry has been working on shifting from fee-for-service to value-based care delivery. The two models differ in the way providers are reimbursed for the care they...

Medicare Advantage Overpayments Expected to Surpass $75B in 2023

by Victoria Bailey

Medicare Advantage overpayments may exceed $75 billion in 2023 due to favorable selection of Medicare Advantage plans, data from the USC Schaeffer Center for Health Policy & Economics...

Medicare Pays Medicare Advantage Plans 6% More Than FFS Medicare

by Kelsey Waddill

Medicare Advantage enrollment as a share of overall Medicare enrollment continued to rise in 2022, but payment inequity calls for serious reforms, according to a presentation from MedPAC. The Medicare...

19 States Must Align Medicaid Vaccine Coverage Policies with IRA

by Kelsey Waddill

Almost two-fifths of US states—particularly those that have avoided Medicaid expansion—will need to change their Medicaid vaccine coverage policies in order to align with the Inflation...

How Payers Can Move Providers Along Value-Based Care Continuum

by Kelsey Waddill

Payers can offer essential support to providers starting their journey through the value-based care continuum, while further research on value-based care in Medicare Advantage can help inform payers about best practices in this...

Key Advantages of Medicare Advantage Plans Versus FFS Medicare

by Kelsey Waddill

Medicare Advantage plans may provide better access to care and lower healthcare spending for enrollees, compared to fee-for-service Medicare, according to a study from ATI Advisory conducted on...

CMS: 2023 Medicare Advantage, Part D Rate Sees 8.5% Revenue Boost

by Kelsey Waddill

CMS announced an 8.5 percent boost on average to payer revenues next year in the 2023 Medicare Advantage and Part D Rate, according to a CMS press release. This final rate announcement was higher than...

MedPAC Releases Medicare Advantage Recommendations, BMA Reacts

by Kelsey Waddill

MedPAC’s March 2022 recommendations to Congress for Medicare Advantage payment policies have roused reactions from payers, specifically Better Medicare Alliance. At the beginning of the report...

MACPAC Shares Spending Trends Among Dual Eligible Beneficiaries

by Kelsey Waddill

MACPAC has released data on utilization and healthcare spending trends among dual eligible beneficiaries in calendar year 2019. First, the report assessed dual eligible use of certain Medicare...

More Medicare Beneficiaries with COPD Enrolled in FFS Than MA

by Victoria Bailey

The majority of Medicare beneficiaries with chronic obstructive pulmonary disease (COPD) are enrolled in fee-for-service Medicare, but the share of beneficiaries in Medicare Advantage plans is...

Medicaid Managed Care Models May Improve Outcomes for Elderly, Disabled

by Victoria Bailey

Transitioning elderly and disabled Medicaid beneficiaries from fee-for-service Medicaid to a managed care model may lead to improved health outcomes and more than $100 billion of savings for states and...

Humana Shares 2020 Medicare Advantage Value-Based Care Results

by Kelsey Waddill

Humana’s Medicare Advantage value-based care efforts helped improve hospitalization rates and preventive care during the coronavirus pandemic, the payer shared in its value-based care...

Providers Share Benefits of Medicare Advantage During COVID-19

by Kelsey Waddill

There has been a lot of valuable conversation around the benefits that Medicare Advantage health plans can offer to consumers, but now providers have offered their perspectives on this form of health...

UnitedHealthcare Shares Growth, COVID-19 Impacts, 2022 Forecast

by Kelsey Waddill

UnitedHealthcare saw its revenue rise 11 percent in the third quarter of 2021 to hit $55.9 billion, the payer announced in its earnings report. “Third quarter 2021 operating earnings were $2.7...

Medicare Advantage COVID-19 Hospitalizations Were Lower Than FFS

by Kelsey Waddill

Updated 11/10/21: This article has been updated to elucidate the differences between Medicare Advantage beneficiaries' and fee-for-service Medicare beneficiaries' use of telehealth and...

How Benefit Design Can Steer Employees Toward High-Value Care

by Kelsey Waddill

When pursuing value-based care, employers have the capacity—in collaboration with their payer or third-party administrator partners—to steer their employees toward high-value care,...

Proposed Policy Would Boost Access to Medicare Dental Benefits

by Kelsey Waddill

Updated 9/13/21: This article has been updated to reflect that AHIP has taken a stance regarding the potential outcomes if the proposed policy passes. A previous version of the article incorrectly...

How Payers Can Support Population-Based Payment Model Uptake

by Kelsey Waddill

As the healthcare industry gravitates toward value-based care, population-based payment models have become the golden fleece for payers, the ultimate state of value-based care payment. Unfortunately...

Racial Care Disparities May Be Lower in Medicare Advantage Plans

by Kelsey Waddill

Medicare Advantage plans may better address racial care disparities than fee-for-service Medicare, according to the second in a series of reports that ATI Advisory has prepared for Better Medicare...

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