Medicare Reimbursement

MA Payment Reductions May Impact Value of Healthcare for Beneficiaries

February 29, 2024 - The proposed 2025 Medicare Advantage Advance Notice would impact the value of healthcare for beneficiaries, resulting in higher costs, according to an analysis from the Berkeley Research Group (BRG). CMS estimated that the policies in the Advance Notice will increase Medicare Advantage plan revenues by 3.70 percent but reduce the 2025 benchmark...

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BMA Asks CMS to Rethink Medicare Advantage Risk Adjustment Model Changes

by Victoria Bailey

Better Medicare Alliance (BMA) has urged the Centers for Medicare and Medicaid Services (CMS) not to finalize its proposed changes to the Medicare Advantage risk adjustment model, stating that they...

How Employers Can Achieve a Fair Price in Hospital Negotiations

by Kelsey Waddill

Across the nation, Americans are feeling the pressure of escalating prices in nearly every area of life, from the grocery store to the clothing store to the gas pump. The hospital room is no exception. Hospital costs represent a...

Provider Acceptance High for Privately Insured, Medicare Patients

by Victoria Bailey

Most office-based physicians accept both new Medicare patients and new privately insured patients, indicating that Medicare beneficiaries have similar access to physicians as individuals with private...

Medicare Will Cover OTC Coronavirus Tests At The Counter

by Kelsey Waddill

CMS has announced that Medicare will cover over-the-counter coronavirus tests. Medicare beneficiaries will be able to access free over-the-counter coronavirus tests through covidtests.gov. The tests...

Key Factors Behind How Much Commercial Insurers Pay Providers

by Kelsey Waddill

Commercial payers have been experiencing higher healthcare spending than fee-for-service Medicare due to higher prices, according to a report from the Congressional Budget Office (CBO). CBO observed...

AHIP Protests Medicare Coverage of Innovative Technology Rule

by Kelsey Waddill

As CMS reconsiders the Medicare Coverage of Innovative Technology (MCIT) rule which was finalized in mid-January 2021, America’s Health Insurance Plans (AHIP) has expressed its concerns regarding...

CMS Announces Medicare Coverage for Short-Term COVID-19 Therapy

by Kelsey Waddill

CMS announced that Medicare coverage will now extend to monoclonal antibodies for coronavirus treatment in certain cases. Monoclonal antibodies are lab-constructed antibodies, the National Institute...

CMS Releases Vaccine Coverage Plan, Medicare Reimbursement Rate

by Kelsey Waddill

CMS has released its Medicare reimbursement rate and official coverage strategy for the coronavirus vaccine when one is approved. For more coronavirus updates, visit our resource page, updated...

Surprise Billing Policies May Decrease Commercial Payer Premiums

by Kelsey Waddill

For three major payers, surprise billing policies had an impact on premiums, a study published in the American Journal of Managed Care found. The researchers used data from the Health Care Cost...

Private Payers Pay Hospitals 247% of Medicare Reimbursement Rate

by Kelsey Waddill

Private payers are paying hospitals 2.5 times more than the Medicare reimbursement rate and employers have a role to play in rectifying the negotiating process, a recent RAND Corporation (RAND) study...

Private Payer COVID-19 Reimbursement Rates Are Twice Medicare Rates

by Kelsey Waddill

Private payers are paying far more for coronavirus-related healthcare services than Medicare, a recent Kaiser Family Foundation brief discovered. “Private insurance payments for inpatient...

Role of Market Share In Payer-Provider Reimbursement Negotiations

by Kelsey Waddill

Private payers pay nearly double the amount that Medicare pays for certain services and a hospital’s market share play a significant role in the positive margin, a recent literature review...

Public, Private Payers Offer Upfront Reimbursement Amid COVID-19

by Jacqueline LaPointe

Public and private payers are looking to support provider organizations during the unprecedented COVID-19 crisis by advancing claims reimbursement and relaxing certain billing requirements, like prior...

How Payers Can Help Reform Behavioral, Mental Health Parity

by Kelsey Waddill

Henry Harbin, MD, a psychiatrist and an advisor to The Bowman Family Foundation, and his team were somewhat hopeful in 2017 after publishing their report on mental health parity and disparities from...

CMS Considers AI and Value-Based Care Fraud Prevention Strategies

by Kelsey Waddill

CMS sent out two requests for information, one on program integrity issues regarding the fee-for-service to value-based care transition and the other on how to evolve data analytics and artificial...

Premium-Cutting CO Public Option Plan Sparks Payer Concerns

by Kelsey Waddill

Colorado officials said that the state’s public option plan would save Coloradans 9 to 18 percent or more on monthly premiums, but payers and providers have concerns. The state released a draft...

New Executive Order Pledges Increased Support for Medicare Advantage

by Kyle Murphy, PhD

On Thursday, President Trump issued the Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors that will authorize the Department of Health & Human Services to expand...

Proposed Rule to Expand Value-Based Payment in Home Healthcare

by Kelsey Waddill

On July 11, CMS proposed a rule that would start the transition to value-based payment in the home healthcare field and make a home infusion benefit available to Medicare...

Hospital Payment Disparities Emerge Among Private Payers, Medicare

by Sara Heath

A new report from the RAND Corporation argues that private payers should rework their contracts with hospitals to align their payment rates with those seen in Medicare plans. The report, which looked...

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