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The use of prior authorizations in the Medicare Advantage (MA) program has risen significantly, correlating with increased enrollment, according to a KFF report. In 2022, over 46 million prior authorization requests were submitted, up from 37 million in 2019, with the average number of requests per enrollee remaining steady at 1.7. While 90.4% of these requests were fully approved, denial rates increased to 7.4% from 5.7% in 2019, with 83% of appealed denials being overturned. Healthcare groups express concern that excessive prior authorizations are burdensome, delaying necessary care and contributing to clinician burnout. Legislative efforts, such as the Improving Seniors' Timely Access to Care Act, aim to streamline the prior authorization process, promoting transparency and reducing delays. However, the bill faces challenges, including cost concerns raised by the Congressional Budget Office, potentially delaying its passage. The bill's supporters are working to address these issues to facilitate its approval. Our team of professionals assists with prior authorizations by streamlining the submission process, ensuring timely approvals, and reducing administrative burdens. We provide expert guidance on compliance, manage appeals for denied requests, and collaborate with healthcare providers to improve efficiency, ultimately enhancing patient care and access to necessary services. We are the One! #revenuecycle #revenuecyclemanagement #priorauthorization #medicalbilling #medicalcoding #healthcare #healthcaretechnology #accountsreceivables #denialmanagement #consulting #management #implementationpartner MedPage Today

The 2024 presidential election has set the stage for significant changes in the U.S. healthcare system during President-elect Donald Trump’s second term. In our latest article, "Trump’s 2024 Victory: What’s Next for Healthcare? Impacts and Predictions," VMG Health experts Don Barbo, Alexander Malin, and Jackson Fish provide an in-depth analysis of the potential impacts on payers, providers, and the broader healthcare market. Key highlights include: - The Medicare Advantage program is expected to continue growing with strong market optimism. - Medicaid faces uncertainty due to proposed funding cuts and stricter eligibility requirements. - Providers will need to navigate regulatory shifts and may find opportunities for innovation and increased efficiency. The article also examines early market reactions, policy proposals, and leadership nominations that could influence the trajectory of the healthcare industry over the next four years. Read the full article here: https://lnkd.in/gFidSWrT #HealthcarePolicy #MedicareAdvantage #Medicaid #HealthcareInnovation

Over 100 hospitals, health systems, and providers have jointly advocated for enhanced Centers for Medicare & Medicaid Services oversight regarding Medicare Advantage (MA) denials. Premier Inc., a leading healthcare services company, spearheaded the initiative, urging CMS Administrator Chiquita Brooks-LaSure to mandate thorough data collection on MA claim denials and enforce compliance with Medicare coverage guidelines.   Premier's survey findings underscored the severity of the issue, revealing that while 15% of claims to private payers are denied, Medicare Advantage claims face a slightly higher denial rate of 15.7%. Moreover, hospitals incur an average administrative cost of $47.77 per appeal for denied Medicare Advantage claims.   In their letter to CMS, the healthcare entities emphasized the importance of monitoring MA plans' expenditure on direct patient care to ensure alignment with beneficiaries' entitlements. Notable healthcare providers, including CommonSpirit Health, Ascension, and AdventHealth, joined the call for CMS action.   Our RCM team plays a vital role in supporting hospitals by analyzing denial patterns, identifying underlying causes, and implementing effective strategies to minimize denials. Leveraging our expertise in Medicare Advantage regulations, we facilitate efficient appeals processes and advocate for fair reimbursement, ultimately striving to alleviate financial burdens on hospitals and uphold patient care standards.   We are the One!   #revenuecycle #revenuecyclemanagement #priorauthorization #medicalbilling #medicalcoding #healthcare #healthcaretechnology #accountsreceivables #denialmanagement #consulting #management #implementationpartner Becker's Healthcare

The fact that CMS is intervening as a means to sustain healthcare services lets you know the affects of this breach will leave ripples for a long time. It’s time to pull up your sleeves to do what you can to help your organizations stay above water. #medicare #medicalbilling #aapc #reimbursement #medicalbillingandcoding

🌟 Exciting Insights from the Latest Harvard-Inovalon Medicare Study! 🌟 As professionals in the Medicare Advantage space, we’re always on the lookout for data that underscores the efficacy and efficiency of MA plans. A recent study by Harvard and Inovalon has brought some compelling findings to light, showing that Medicare Advantage not only reduces healthcare expenditures but also maintains high levels of care compared to traditional Medicare Fee-for-Service. Here are some key takeaways: - MA enrollees experience over 50% fewer inpatient stays and 22% fewer emergency visits compared to FFS, with no significant reduction in primary care or prescription drug services. - Overall, MA shows a 12% reduction in health expenditures, highlighting its efficiency in managing healthcare resources. At Sonder Health Plans, we're proud to say that we're already implementing many of the strategies that make Medicare Advantage so beneficial. Our focus on care coordination and preventive care isn’t just about keeping costs down—it's about providing a foundation for healthier, happier lives for all our members. This study reinforces the value of the Medicare Advantage program and the potential for more innovative, cost-effective care models. Let’s continue to push forward, driving improvements that matter. #MedicareAdvantage #HealthcareInnovation #SonderHealthPlans

🌟 Exciting News in Medicare Policy! 🌟 The Centers for Medicare & Medicaid Services (CMS) has announced significant updates in the Contract Year 2025 Medicare Advantage and Part D Final Rule. These changes focus on enhancing access, promoting competition, and ensuring that Medicare Advantage and Part D plans best serve enrollees' needs. At Abel Personnel, we understand the importance of having the right team in place to navigate complex healthcare regulations. Our expertise in staffing solutions ensures that healthcare organizations can meet these new requirements seamlessly. Looking for enrollment staffing solutions? Reach out to Abel Personnel at 717-561-2222 or visit www.abelpersonnel.com to discover how we can support your needs. Read more about the Contract Year 2025 Medicare Advantage and Part D Final Rule here: https://lnkd.in/e--b3t47 #MedicarePolicy #EnrollmentSolutions #HealthcareStaffing

"Stay updated on Medicare Advantage: Rates, pharmacy innovations, benefits, care disparities, enrollment trends, and evolving landscape insights." #MedicareAdvantageInsights #HealthcareTrends #Healthcare #DistilINFO. https://zurl.co/xlrY

The updated federal policy, confirming that Medicare Advantage plans must pay for hospital stays in accordance to the Two-Midnight Rule, is sparking much debate within the healthcare industry. In this Modern Healthcare article, insurers like Humana and Aetna are reporting higher utilization costs due to more inpatient stays, while others like UnitedHealthcare haven't seen a significant financial hit. Hospitals may see a revenue boost, but some report no change. Unresolved issues remain, including the debate over insurer use of artificial intelligence to review claims and hospitals' concerns about potential delays or denials of coverage for Medicare Advantage patients. Overall, we expect hospitals to see an increase in reimbursements as insurers who have not been complying with the Two-Midnight Rule will hopefully now comply. Stay tuned as we continue to monitor developments!

The AHA released an interesting infographic related to Medicare reimbursement, which shows that Medicare payment rates hit an all-time low compared to costs in 2022. Health systems will need to look to more drastically subsidize through other payment mechanisms (i.e., commercial, alternative payment models, etc.), or further diversify their revenue streams: https://buff.ly/3ud5uzs #WhitecapTrendsFinance

In this MedPage Today article “Prior Authorizations on the Rise in Medicare Advantage, Report Finds,” there has been a significant increase in prior authorization requests from Medicare Advantage plans. One quote caught our attention… “Of the requests (in 2022) submitted, 90.4% were approved in full, while 7.4% were denied -- an increase from 5.7% in 2019…” The quote continues, “We know that if 90% of prior authorization requests are approved, then these programs are not targeted efforts to ensure appropriate utilization," Furr continued. "Instead, they are arbitrary, unnecessary paperwork burdens that, at best, slow down access to care and increase burnout, and at worst completely deny access to care.” If you are struggling with prior authorization resources or technology, Abax Health’s industry leading prior authorization technology enabled services can help. Drop us an email at info@abaxhealth.com https://lnkd.in/enFY69Yi