priorauthorization

This is one of a number of blogs that will appear on my daughter. I call her Kitty. She is a wonderfully talented, bright, and empathetic individual in her late ‘20s. She and I agreed I would write this series to impart how important health coverage is. Not only is her decision to have surgery courageous, but so is her decision to share her journey through me. The principal reason to share the journey is because we both want to explain what many average Americans go through financially when they have major operations and do not have the best insurance or no insurance at all. My daughter is privileged to come from a well-off family and to have consistent and robust insurance. This will mean that she will pay a tiny amount for a surgery with a sticker price in the hundreds of thousands of dollars. But for uninsured and

In my January 22, 2024 Healthcare Labyrinth Blog ( https://www.healthcarelabyrinth.com/great-news-for-insurers-and-medicare-beneficiaries-january-2023-to-january-2024-medicare-advantage-growth-rebounds/ ), I told you about the exciting news of Medicare Advantage’s (MA) continued strong growth (from January 2023 to January 2024) as well as a nice recovery from a bit of a sluggish increase from January 2022 to January 2023. As I always do, I publish short follow-up blogs in the first few months of each year given continuing growth outside of the main enrollment season of October 15 to December 7. The key takeaways from the January 22, 2024 blog were: So what happened with February enrollment? A change over the past few years now allows all members enrolled in an MA plan to change to a different MA plan or go back to traditional Medicare (and also get a standalone Part D plan) between January 1 and March 31 of each year. Previously, an MA member could only

A number of folks have texted, LinkedIn messaged, or emailed and asked if I would give an overview of some of the major compliance and regulatory issues Medicare Advantage (MA) plans need to be aware of as the 2024 year gets going. Here is my best take on the major issues from a compliance and regulatory standpoint: Audits in full swing I am hearing from health plan friends that MA audits have already begun this year with January notices. As promised by the Centers for Medicare and Medicaid Services (CMS), regular program audits are being supplemented with ad hoc audits concerning the 2024 rule requiring major changes to how MA plans perform prior authorization (PA) and utilization management (UM). In addition to adding the ad hoc audits for those under regular program audit, plans can be noticed for just an ad hoc audit as well.  In general, the new rule