The disadvantages of Medicare Advantage programs can extend beyond frustration for patients and lower reimbursement rates for hospitals.
A recent report from the U.S. Health and Human Services Department Office of Inspector General put a sharper focus on questionable practices in certain Medicare Advantage programs from certain commercial health insurance companies. Three health insurance companies were found to have used codes that did not match patient medical records yet secured more than $140 million in federal reimbursements.
From the article:
Humana, HealthAssurance Pennsylvania — a unit of CVS Health subsidiary Aetna — and EmblemHealth deny the accusations and reject the OIG’s recommendations that the Centers for Medicare and Medicaid Services recoup a portion of the alleged overpayments.
According to the OIG reports, the three insurers misused diagnosis codes to generate higher federal reimbursements under the Medicare Advantage risk-adjustment program. The agency:
- Estimates that EmblemHealth received at least $130 million more than it should have in 2015
- Alleges Humana collected at least $13.1 million too much in 2017 and 2018; and
- HealthAssurance received $4.2 million more than they should have in 2018 and 2019.
See what else Groundswell Health is working on in healthcare >>
Paul Revere’s midnight ride gets all the glory….
But let’s talk about the Revolution’s real heroes: the mass communicators Who would’ve thought must-see TV for 2025 would be
Hiss Happens: That’s Why Rural Hospitals Matter.
In a routine strategic planning session, HRMC leaders mentioned a patient’s close call with a rattlesnake, and the Groundswell Health team knew it would be a message that would resonate especially as legislators considered crucial rural healthcare funding and other rural hospitals struggle to invest and maintain profitability.
Empowering rural hospitals to engage their communities.
Amplifying Rural Voices Empowering rural hospitals to engage their communities. Blog, Social, Outreach, Flyers About
Increasing Patient Volume for Haskell Memorial Hospital
Haskell memorial hospital Increasing Patient Volume Significantly expanding online reach. Website, Digital Targeting About
Medicare Advantage Headlines >>
Ranking Medicare Advantage Insurers by Prior Authorization Denial Overturn Rates
While the majority of Medicare Advantage insurers overturn prior authorization denials when those decisions are appealed, the appeal process adds
Texas Leads Nation in Number of Counties with MA Penetration Exceeding 75 Percent
Of the 38 counties in the U.S where Medicare Advantage enrollment is 75 percent or more, six are in Texas,
