Recent MA News | Clariti

Medicare Advantage is bad for patients and bad for investors

February 28, 2024

STAT

“In 2023, enrollment in Medicare Advantage, the version of Medicare run by private insurers, surpassed 50% of eligible beneficiaries for the very first time. Going by this headline, or perhaps…

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Class action suit targets Medicare Advantage insurer’s use of AI to end rehab stays

December 14, 2023

McKnights

Two skilled nursing patients filed a class action suit against Humana Tuesday — alleging their Medicare Advantage benefits were cut prematurely short because of Humana’s wrongful reliance on artificial intelligence.…

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UnitedHealth pushed employees to follow an algorithm to cut off Medicare patients’ rehab care

November 14, 2023

STAT

The nation’s largest health insurance company pressured its medical staff to cut off payments for seriously ill patients in lockstep with a computer algorithm’s calculations, denying rehabilitation care for older…

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How UnitedHealth’s acquisition of a popular Medicare Advantage algorithm sparked internal dissent over denied care

July 11, 2023

STAT

Frustration was boiling into open conflict within NaviHealth, a company that uses computer predictions to help control the cost of caring for millions of older and disabled Americans on privatized…

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CMS Releases New Data on Medicare Advantage Beneficiaries’ Use of Skilled Nursing

June 12, 2023

Skilled Nursing News

In 2019, there were about 46.6 skilled nursing facility stays per 1,000 Medicare Advantage beneficiaries on a national basis. That’s according to data released Monday by the Centers for Medicare…

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Medicare Advantage Is Neither Medicare Nor an Advantage

February 1, 2023

Rowan Report

Medicare Advantage is a money-making scam. I should know. I helped to sell it. Right now, well-funded lobbyists from big health insurance companies are leading a campaign on Capitol Hill…

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CMS’ Medicare Benefit Policy Manual

October 5, 2023

The Medicare Benefit Policy Manual is published online by the U.S. Centers for Medicare & Medicaid Services, or CMS. Its used by health care providers, contractors, Medicare Advantage companies and…

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With Medicare Advantage at a crossroads, will regulators keep plans’ unpopular deny-and-delay tactics in check?

February 24, 2025

McKnights

It’s the rare issue where consumer advocates and nursing home providers are in near lockstep, but on this they passionately agree: Improved rules for Medicare Advantage plans made over the…

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Reduce Insurance Claim Denials

February 20, 2025

Rowan Report

The healthcare landscape continues to evolve, and with it, so do the complexities of billing and reimbursement. Home health and hospice agencies face unique challenges, from managing PDGM requirements on…

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UnitedHealth AI Denials Lawsuit: Medicare Advantage Coverage Disputes

February 14, 2025

STAT

A class action lawsuit was filed in November 2023 against UnitedHealth Group and a subsidiary alleging that they are illegally using an algorithm to deny rehabilitation care to seriously ill…

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Mid-stream shift: Trump team to weigh unfinished Medicare Advantage coverage rules, program’s future

February 5, 2025

McKnights

In this episode, Nicole Fallon, vice president of integrated services and managed care for LeadingAge, breaks down what we know about the future of MA. First up: What happens to…

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Best Practices for Medicare Advantage Case Management and Appeals

February 1, 2025

Clariti

GAINING CLARITY: This Clarity Guide details case management strategies for post acute providers to improve their work with managed care payers.

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Negotiating to Win at Managed Care Contract Negotiations

February 1, 2025

Clariti

GAINING CLARITY: This Clarity Guide offers best practices for post-acute providers working on agreements with Medicare Advantage payers.

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A Guide to Medicare Advantage and Managed Care Contracting for Post Acute Providers

February 1, 2025

Clariti

GAINING CLARITY: This Clarity Guide details the unique features and considerations for post acute providers working with Medicare Advantage payers.

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Medicare Advantage Insurers Made Nearly 50 Million Prior Authorization Determinations in 2023

January 28, 2025

GAINING CLARITY: This must-read for skilled nursing facilities dissects key trends shaping the 2024 Medicare Advantage landscape, directly impacting resident referral patterns and facility bottom lines.

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CMS Releases Proposed 2026 Payment Policy Updates for Medicare Advantage and Part D Programs

January 10, 2025

Today, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2026 Advance Notice for the Medicare Advantage (MA) and the Medicare Part D Prescription Drug Programs…

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Do Medicare Beneficiaries Under Accountable Care or Medicare Advantage Use Lower Quality Nursing Homes?

December 31, 2024

Journal of the American Geriatrics Society

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Medicare Advantage Fraud: Insurer to Pay $100M in Settlement

December 20, 2024

A western New York health insurance provider for seniors and the CEO of its medical analytics arm have agreed to pay a total of up to $100 million to settle…

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Expanding Medicare Advantage co-pays may leave nursing homes without cash they’ve earned

December 9, 2024

McKnights

An increasing number of Medicare Advantage insurers are expected to institute nursing home co-pays starting Jan. 1, a change that could further hit providers already struggling to collect fair reimbursement…

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Medicare Spending was 27% More for People who Disenrolled from Medicare Advantage than for Similar People in Traditional Medicare

December 6, 2024

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HHS-OIG’s Efforts Result in $7.13 Billion in Expected Recoveries and Receivables

December 4, 2024

America’s taxpayers could see recoupment of billions of dollars in misspent Medicare, Medicaid, and other health and human services funds as a result of work by the Department of Health…

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Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program

November 26, 2024

On November 26, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would revise the Medicare Advantage (MA) Program, Medicare Prescription Drug Benefit Program (Part…

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Medicare Advantage Proves To Be the ‘Most Profound’ Disruptor for Nursing Homes, Reshaping Payer Dynamics

November 18, 2024

Skilled Nursing News

Of the many significant factors affecting the skilled nursing industry in the last five years, Medicare Advantage was named as a major disruptor, as cost reports show a shift in…

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Medicare Advantage 2025 Spotlight: A First Look at Plan Offerings

November 15, 2024

Over the last decade, Medicare Advantage, the private plan alternative to traditional Medicare, has taken on a prominent role in the Medicare program. In 2024, nearly 33 million Medicare beneficiaries are enrolled…

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How to Survive Medicare Advantage in Home Health

November 15, 2024

Rowan Report

Navigating the complexities of Medicare Advantage continues to be a sticking point for organizations trying to scale their business. In an education session at the 2024 Axxess Growth, Innovation and Leadership Experience…

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What the Outcome of the Election Could Mean for Medicaid

November 14, 2024

On the campaign trail, both former President Donald Trump and Vice President Kamala Harris are eager to portray themselves as guardians of Medicare. Each presidential candidate accuses the other of…

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The Sickest Patients Are Fleeing Private Medicare Plans—Costing Taxpayers Billions

November 11, 2024

Wall Street Journal

Patricia Greene had spent a month recovering from a devastating stroke when her Medicare Advantage insurer, a unit of UnitedHealth Group, decided to stop paying for her nursing home. The…

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