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UnitedHealth Doctors Got Diagnoses Checklists To Boost Medicare Payouts

January 2, 2025 Morning Briefing

The Wall Street Journal reports how UnitedHealth provided lists of potential, often obscure diagnoses to its doctors and forced them to weigh in on them for each Medicare Advantage patient, in order to capitalize on the government system that pays private insurers based on how sick doctors say a patient is.

4.2% Medicare Pay Raise Coming To Nursing Homes In Fiscal 2025

August 1, 2024 Morning Briefing

The rate is higher than the 4.1% the Centers for Medicare and Medicaid Services proposed in March. Also in the news: Humana predicts losing a few hundred thousand Medicare Advantage members next year; Google is not renewing its contract with Amazon One Medical for staff care; and more.

4 Months After Cyberattack, VA Grapples With Paying Providers

June 26, 2024 Morning Briefing

The attack hit a third-party company that manages some processes for the Department of Veterans Affairs. Officials say they’re still working to clear a backlog of payments to pharmacies and other providers. Also in the news: AI use by Medicare Advantage insurers.

Spotlight Falls On ‘Two-Midnight Rule’ For Medicare Patient Hospital Stays

May 16, 2024 Morning Briefing

Modern Healthcare reports on how providers and Medicare Advantage companies are reacting to the new policy that allows more patient visits to be categorized as higher-cost inpatient care. Separately, reports explain how Blackstone Equity Healthcare is lowering costs.

Democrats Plan to Expand Medicare Hearing Benefits. What Can Consumers Expect?

By Rachana Pradhan November 5, 2021 KFF Health News Original

KHN answers questions for seniors about how this new benefit might work.

Morning Briefing for Wednesday, September 27, 2023

September 27, 2023 Morning Briefing

Covid vaccine attitudes, shutdown watch, ARPA-H hubs, Medicare Advantage premiums, abortion law, drug pricing, and more are in the news.

CMS-Proposed Rules Would Cap Medicare Advantage Broker Incentives

November 7, 2023 Morning Briefing

The Centers for Medicare and Medicaid Services are launching a second-wave effort to target Medicaid Advantage marketing practices in an effort to ensure older Americans have access to Medicare supplemental benefits and drug coverage.

Trump Chooses Dr. Mehmet Oz To Run Medicare And Medicaid Agency

November 20, 2024 Morning Briefing

A former cardiothoracic surgeon and professor at Columbia University, Dr. Oz is better known to the public as a TV personality and has no experience running a government agency. If confirmed as the CMS administrator, he would be influential in major policies around how states run their Medicaid programs and regulations on Medicare Advantage private plans.

La catarata de información sobre la inscripción a Medicare no explica bien las opciones de Medigap

By Harris Meyer November 9, 2021 KFF Health News Original

En parte porque las políticas sobre el acceso y los costos de Medigap cambian dependiendo del estado, o por la información confusa, muchos beneficiarios no eligen lo que más les conviene.

Cigna To Sell Its Medicare Business To Health Care Service Corp.

February 1, 2024 Morning Briefing

Cigna is shedding its troubled Medicare Advantage, Medigap, and Medicare part D plans that cover 3.6 million people. The business will be sold to Health Care Service Corp., a Blue Cross Blue Shield insurer.

Cyberattack Insurance In The Spotlight After UnitedHealth Hack

March 21, 2024 Morning Briefing

Meanwhile, UnitedHealth Group said its Change Healthcare subsidiary’s systems for handling medical claims were back online, about a month after the attack. Also in the news: Medicare Advantage, hospital staff shortages, and more.

CMS: Medicare Advantage Premiums To Slightly Rise Next Year

September 27, 2023 Morning Briefing

The Centers for Medicare and Medicaid Services estimates that Medicare Advantage plan premiums will increase from $0.64 per month on average in 2024. Separately, GAO says that CMS does not have useful data on private equity investments in the nursing home industry.

Hospitals Said They Lost Money on Medicare Patients. Some Made Millions, a State Report Finds.

By Fred Clasen-Kelly October 25, 2022 KFF Health News Original

A North Carolina state treasurer’s report found hospitals give conflicting information about whether they profit from Medicare patients. Experts said the findings are significant because they suggest the federal government has failed to closely watch the billions of dollars in tax breaks that nonprofit hospitals have received.

Say What? Hearing Aids Available Over-the-Counter for as Low as $199, and Without a Prescription

By Phil Galewitz October 17, 2022 KFF Health News Original

The cheaper over-the-counter aids are for adults with mild to moderate hearing loss — a market of tens of millions of people, many of whom have until now been priced out because prescription devices can cost thousands of dollars.

Senate Finance Panel Grills Medicare Advantage Brokers Over Incentives

October 19, 2023 Morning Briefing

The Senate Finance Committee held a hearing Wednesday, questioning national insurance brokers about their practice in guiding Medicare Advantage enrollees through choosing among many plan options. Financial incentives and privacy were among the issues discussed.

Humana Shares Plummet After Feds Slash Rating

October 3, 2024 Morning Briefing

Humana’s stock took a tumble after the provider admitted to the SEC that only about 1 in 4 of its members were signed up to Medicare Advantage plans rated four stars or more. Meanwhile, CMS is making it harder in 2025 for insurers to get top marks, due to changes in the way stars are calculated.

Health Care Providers Indirectly Hit By Medicare Advantage Star Rating Slips

November 21, 2023 Morning Briefing

The argument runs thus: Declining ratings prompt insurers to seek cost savings that then impact health providers. Separately, worries emerge that new nursing home ownership transparency rules may lead to private equity exits. Also in the news: cybersecurity, ADHD drugs, and more.

Demócratas proponen ampliar beneficios de Medicare para la audición. ¿Qué pueden esperar los consumidores?

By Rachana Pradhan November 5, 2021 KFF Health News Original

Investigaciones han demostrado que la pérdida de la audición puede socavar la calidad de vida de las personas mayores, lo que conduce a la soledad, el aislamiento, la depresión, y trastornos de la comunicación.

Humana Health Plan Overcharged Medicare by Nearly $200 Million, Federal Audit Finds

By Fred Schulte April 20, 2021 KFF Health News Original

Medicare Advantage company may face record penalty over alleged billing errors.

Regulations Take Aim At Misleading Medicare Ads As Enrollment Opens

October 17, 2023 Morning Briefing

New Biden administration rules crafted to combat deceptive Medicare marketing tactics face their first big test this enrollment season. Other open enrollment news relates to coinsurance changes, Medicare Advantage, and more.

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