CMS Archives | Clariti

CMS’ Medicare Benefit Policy Manual

October 5, 2023

CMS

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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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

KFF

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

December 4, 2024

OIG

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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Best Practices for Medicare Advantage Case Management and Appeals

December 1, 2024

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

December 1, 2024

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

December 1, 2024

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

November 26, 2024

CMS

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

KFF

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

KFF

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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Nursing Home Providers Adjust to Optum Exiting Medicare Advantage I-SNPs in Several Regions

November 5, 2024

Skilled Nursing News

Optum is scaling back its Medicare Advantage Special Needs Plans for nursing home and assisted living residents in several regions. The health care services arm of insurance giant UnitedHealth Group…

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It’s UnitedHealth Group’s world — we just live in it

November 4, 2024

McKnights

…On Oct. 24 a report from the US Department of Health and Human Services Office of the Inspector General was published that was just the latest evidence of how MA insurers pilfer…

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Medicare Advantage Plans With High Numbers Of Veterans: Enrollment, Utilization, And Potential Wasteful Spending

November 2, 2024

Health Affairs

Medicare Advantage (MA) plans are increasingly enrolling veterans. Because MA plans receive full capitated payments regardless of whether or not veterans use Medicare services, the federal government can incur substantial…

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Denied but in denial no longer: Providers share successful Medicare Advantage strategies

October 31, 2024

McKnights

Document. Don’t delay. Designate a handler. Those were among top tips provided by managed care and skilled nursing experts who have fine-tuned their approach to getting resident care approved by…

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UnitedHealth Study: Is Medicare Advantage Killing Seniors

October 25, 2024

Rowan Report

Dr. Steve Landers has long been eloquent in his speaking and writing about the importance of Home Health over the years. Though I was already impressed, I gained a new…

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Refusal of Recovery: How Medicare Advantage Insurers Have Denied Patients Access to Post-Acute Care

October 24, 2024

US Senate

The Senate Homeland Security and Governmental Affairs Committee’s majority staff report on Medicare Advantage highlights three key takeaways regarding overpayments and manipulative practices: Medicare Advantage plans are significantly overpaid: The…

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“Not Medically Necessary”: Inside the Company Helping America’s Biggest Health Insurers Deny Coverage for Care

October 23, 2024

ProPublica

Every day, patients across America crack open envelopes with bad news. Yet another health insurer has decided not to pay for a treatment that their doctor has recommended. Sometimes it’s…

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Transition to Managed Medicaid Causing Chain Reaction of Challenges, as Nursing Homes Also Contend With Redetermination

October 15, 2024

Skilled Nursing News

Multiple states have been working toward a transition to managed Medicaid from the traditional state-run program, but there have been concerns about reimbursement timing and insufficient payment amounts due to…

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

CMS Advancing Interoperability and Improving Prior Authorization Processes Final Rule (CMS-0057-F)

CMS’ Medicare Benefit Policy Manual

Find More Medicare Advantage Resources

CMS’ Medicare Benefit Policy Manual

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

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

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

Best Practices for Medicare Advantage Case Management and Appeals

Negotiating to Win at Managed Care Contract Negotiations

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

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

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

Medicare Advantage 2025 Spotlight: A First Look at Plan Offerings

How to Survive Medicare Advantage in Home Health

What the Outcome of the Election Could Mean for Medicaid

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

Nursing Home Providers Adjust to Optum Exiting Medicare Advantage I-SNPs in Several Regions

It’s UnitedHealth Group’s world — we just live in it

Medicare Advantage Plans With High Numbers Of Veterans: Enrollment, Utilization, And Potential Wasteful Spending

Denied but in denial no longer: Providers share successful Medicare Advantage strategies

UnitedHealth Study: Is Medicare Advantage Killing Seniors

Refusal of Recovery: How Medicare Advantage Insurers Have Denied Patients Access to Post-Acute Care

“Not Medically Necessary”: Inside the Company Helping America’s Biggest Health Insurers Deny Coverage for Care

Transition to Managed Medicaid Causing Chain Reaction of Challenges, as Nursing Homes Also Contend With Redetermination