- Center on Health Equity & Access
- Clinical
- Health Care Cost
- Health Care Delivery
- Insurance
- Policy
- Technology
- Value-Based Care
Medicare Advantage Plans Scrutinized More in CMS Audits
Private insurers managing Medicare Advantage plans likely will be scrutinized more intensely as the Centers for Medicare & Medicaid Services seeks to rectify a "longstanding problem" of improper payments.
CMS recently said it may have overpaid Medicare Advantage plans by as much as $12.4 billion in 2011, amounting to an 11% error rate, compared to an 8.6% rate in traditional Medicare, reported Bloomberg.
To help reduce that error rate, CMS auditors will examine 30 plans to determine whether clinical records justify payments for medical services. The auditors will review 200 patients' medical records and calculate the percentage of improper payments. Medicare will then reduce future payouts to the insurer to recoup any overpayments.
"We're absolutely confident that this is a valid sample to do these audits," Medicare Deputy Administrator Jonathan Blum told Bloomberg.
Read more at: http://tinyurl.com/6w7htgn
Source: FierceHealthPayer; Bloomberg
Navigating Sport-Related Neurospine Injuries, Surgery, and Managed Care
February 25th 2025On this episode of Managed Care Cast, we speak with Arthur L. Jenkins III, MD, FACS, CEO of Jenkins NeuroSpine, to explore the intersection of advanced surgical care for sport-related neurospine injuries and managed care systems.
Listen
Clarifying the Role of EEN Diet as Ulcerative Colitis Therapy
March 12th 2025There is insufficient evidence to support exclusive enteral nutrition as an adjunctive therapy for active ulcerative colitis, despite its good tolerability and low discontinuation rates, according to a systematic review.
Read More
Varied Access: The Pharmacogenetic Testing Coverage Divide
February 18th 2025On this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.
Listen
