November 22, 2023

CMS’ UM Rule for Medicare Advantage Already Being Debated

The new CMS 2024 Medicare Advantage (MA) rule prohibiting the use of most evidence-based criteria by MA plans is already being debated. Hospital lobbies are saying plans are out of compliance and January 1 has not even hit yet. Read my new companion blog at the blog tab on this site. I tell you why this rule is a terrible idea. Additional article here: https://www.modernhealthcare.com/politics-policy/health-plans-2024-medicare-advantage-rule-aha-cms-unitedhealthcare

#hospitals #medicareadvantage #medicare #ncd #lcd #priorauthorization

Link to Article

Interesting Article on Cancer Care Between MA and FFS

Interesting study on cancer care differences between MA and FFS. Touches on prior authorization and networks. Something for MA plans to think about as the PA debate heats up and the new UM rule comes unto effect.

#medicare #medicareadvantage #cancercare #priorauthorization #networkadequacy

Link to Article

FL Blue Using AI to Speed Authorizations

While many plans are being criticized for using AI in claim denials, Florida Blue says it has teamed up with Availity to use AI to speed prior authorizations. Florida Blue says it has rigorous oversight over its use of AI and the technology is helping return prior authorizations faster. It has used AI in 1 million prior authorization requests related to advanced imaging and hip, knee, and other musculoskeletal services. About 75% of requests are authorized in 90 seconds. (May require subscription.)

#flblue #ai #priorauthorization

Link to Article

NYT and KHN Long Term Care Series

Latest article in the Kaiser Health News and New York Times series on the long-term care crisis. This article calls out the status of the LTC policy market — it is unstable and adverse. In my book, The Healthcare Labyrinth (available on this website), I say that LTC policies combined with growing long-term care alternatives and a buy-in approach to government programs are crucial to our future. We need younger generations to be buying such policies to prop up the viability of LTC insuance. As well, the hybrid life-LTC products make sense. Companion article on LTC policies and whether you should buy is at this link: https://kffhealthnews.org/news/article/a-guide-to-long-term-care-insurance/

#nyt #khn #longtermcare #ltc #homecare

Link to Article

“As The AI World Turns” Soap Opera Over

Less than a week after he was fired by the board of OpenAI, Sam Altman is back as CEO. Supportive colleagues and employees threatened to quit if he was not reinstated. Board members who ousted him all resigned. Tremendous victory for Altman.

#ai #healthcare

Link to Article

Great Two-Part Blog on Home-Based Care in Medicare Advantage

Health Affairs Forefront has a two-part blog on home-based care in Medicare Advantage. It traces how the benefit came about and offers constructive ways to expand the availability of the benefit by MA plans. The first article is at the link below. The second is here: https://www.healthaffairs.org/content/forefront/home-based-care-medicare-advantage-part-2-policy-recommendations-equity-and (May require subscription.)

#medicareadvantage #ltc #supplementalbenefits #longtermcare #homecare

Link to Article

— Marc S. Ryan

Leave a Reply

Your email address will not be published. Required fields are marked *

Available Now