13. Medicare Advantage Compliance and Regulatory Trends in 2024

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through the Healthcare Labyrinth website.

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

On this episode of the Healthcare Labyrinth Podcast, Marc explains the 2024 Regulatory and Compliance trends in Medicare Advantage.

The most important change is a new 2024 prior authorisation rule. Marc gives his views on what to expect and how hard CMS may be.

Listen in to learn more about the 2024 Regulatory and Compliance Regime in Medicare Advantage.

Key Takeaways  

Generally, the new rule for audits says plans must only use the national coverage determinations and local coverage determinations in the traditional Medicare program.

It is difficult to see how Medicare Advantage plans will be able to use other criteria to limit the use of expensive inpatient hospital stays.

The new policy will be a disaster for MA plans and costs in the system. MA plans need to find a way to document these costs and build a case to overturn it in the future.

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Episode 9: Is Medicare Advantage Collapsing After Its Boom Or Simply Adjusting

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