Payers and some provider groups are pushing back on a slate of proposed Medicare Advantage regulatory changes from CMS. Here are nine updates about the program Becker's has reported since March 7.
- As CMS prepares to implement tougher risk adjustment data validation audits for Medicare Advantage plans, payers and providers can take steps to boost their compliance efforts.
- Oak Street Health said some of CMS' proposed Medicare Advantage rate changes for 2024 will shift resources away from underserved populations, though the provider group agrees many of CMS' proposed changes will increase integrity in Medicare Advantage.
- More employers are offering Medicare Advantage benefits to their retired employees, but some retirees have concerns about prior authorization and costs.
- New York City leaders greenlit an Aetna-run Medicare Advantage plan for the city's retired municipal employees. Aetna's plan will begin on Sept. 1 for 250,000 retired New York City workers and their dependents, unless they choose to opt out.
- Medicare Advantage plans greatly differ from traditional Medicare plans in several aspects of care quality and cost, research published over the last year shows.
- Medicare Advantage plans are not required to identify when payments claims were denied, hindering fraud, waste and abuse investigations, according to a report from HHS' Office of Inspector General.
- Insurers have urged CMS not to implement proposed risk adjustment payment changes for Medicare Advantage in 2024, but some nonprofit payers say the changes could create a more level playing field for community plans.
- Some provider groups, including the American Medical Group Association and the Medical Group Management Association, have joined in payers' concerns about CMS' proposed changes Medicare Advantage rate changes.
- Humana CEO Bruce Broussard said proposed Medicare Advantage rates will not affect the company's 2024 outlook.