Payer

Audits of BlueCross BlueShield of Tennessee and Inter Valley Health Plan found the organizations' Medicare Advantage plans received millions in overpayments as a result of diagnosis codes submitted to CMS that were not backed up by medical records. 

From premium decreases and study findings to star ratings and plan expansions, here are 14 Medicare Advantage stories Becker's has reported since Sept. 12. 

CMS' Value-Based Insurance Design program for Medicare Advantage plans is growing for 2023, expanding to 52 participating organizations, the agency said Sept. 29. 

A group of senators is asking CMS to clarify whether Medicaid funds can be used to pay for crisis stabilization in facilities with more than 16 beds.

The first drugs negotiated by Medicare are likely to be blood thinners, diabetes treatments and cancer drugs, physicians predicted in a Sept. 30 article for Health Affairs.

Centene and Florida Blue are among the largest donors to Florida's disaster fund support recovery from Hurricane Ian, according to a news release from the state's first lady, Casey DeSantis. 

The North Carolina Department of Health and Human Services is delaying the implementation of its Medicaid managed care behavioral health and intellectual/developmental disabilities tailored plans until April 1. 

Medicare Advantage premiums will decrease for 2023, CMS said Sept. 29, continuing a trend in slight cost reductions for next year across Medicare services. 

Medicaid beneficiaries say communicating with the agency is difficult, and the reapplication process is confusing and cumbersome. 

Health consumer engagement company Icario is launching a Medicaid redetermination service, designed at streamlining the re-enrollment process with many Medicaid beneficiaries set to lose coverage when the COVID-19 public health emergency ends.