Sheryl Gulan的动态

https://lnkd.in/drXkBTiu The Centers for Medicare & Medicaid Services have finalized changes to Medicare Advantage plan capitation rates and Part C and Part D payment policies for 2025. These changes are expected to increase MA plan revenues by an average of 3.7% from 2024 to 2025. The notice includes adjustments to the Part C risk adjustment model, updates to Part C and D star ratings, stability adjustments for the MA program in Puerto Rico, and implementation of changes to the standard Part D drug benefit. CMS also encourages stakeholders to provide feedback through the Medicare Advantage Data Request for Information, with comments due by May 29. #MemberOutreach #MemberEngagement #MedicareCoverage #MedicareAdvantage #MedicarePlans #HealthcareBenefits #MedicareEnrollment #HealthcareAccess #MedicareServices #MemberSupport #Redetermination #MedicareAdvocacy #HealthcareNavigation #MedicareAssistance

https://lnkd.in/eiFUsj5N The Centers for Medicare & Medicaid Services have finalized changes to Medicare Advantage plan capitation rates and Part C and Part D payment policies for 2025. These changes are expected to increase MA plan revenues by an average of 3.7% from 2024 to 2025. The notice includes adjustments to the Part C risk adjustment model, updates to Part C and D star ratings, stability adjustments for the MA program in Puerto Rico, and implementation of changes to the standard Part D drug benefit. CMS also encourages stakeholders to provide feedback through the Medicare Advantage Data Request for Information, with comments due by May 29. #MemberOutreach #MemberEngagement #MedicareCoverage #MedicareAdvantage #MedicarePlans #HealthcareBenefits #MedicareEnrollment #HealthcareAccess #MedicareServices #MemberSupport #Redetermination #MedicareAdvocacy #HealthcareNavigation #MedicareAssistance

The Centers for Medicare & Medicaid Services (CMS) released draft guidelines of how it will approach the IRA for the medicines to be price-controlled in 2027, and the agency’s suggested rules raise more questions than they answer. CMS is still refusing to demand that PBMs ensure that savings are passed to patients, and plans for the administrative structure that will hold the whole program together financially – the Medicare Transaction Facilitator – still remain dangerously underdeveloped. Read more on their draft guidance here: https://lnkd.in/egmbvyb2

CMS Says Nearly Half Of Medicare Fee-For-Service Beneficiaries Are Covered Under ACOs Modern Healthcare (1/29, Bennett, Subscription Publication) reports, “Medicare fee-for-service accountable care organizations are thriving, according to the Centers for Medicare and Medicaid Services.” Almost “half of fee-for-service Medicare beneficiaries, or 13.7 million people, are covered under ACOs this year, a 3% increase, the agency said in a news release.” According to the article, “in 2021, the innovation center declared a goal to have all fee-for-service Medicare enrollees associated with accountable care arrangements by 2030. Since then, CMS has undertaken steps to attract more providers and encourage more ACOs to form.” https://buff.ly/3HBEP2u

What Are Medicare Dual Eligible Special Needs Programs? Dual Special Needs Plans (DSNPs) coordinate care for individuals eligible for both Medicare and Medicaid — otherwise known as dually eligible. Dual Special Needs Plans (DSNPs) are specific Medicare Advantage plans made for duals or dual eligibles. Due to the often-complex nature of social, mental and physical care needs for duals, DSNPs help centralize the care from the two programs and provide patient-focused care that is easier to navigate. Dual Eligible Special Needs Plans (D-SNPs) enroll individuals who are entitled to both Medicare (title XVIII) and medical assistance from a state plan under Medicaid (title XIX). States cover some Medicare costs, depending on the state and the individuals eligibility. Contact Janis Lakkees for all your Medicare needs in Upland, CA.

On June 28, the Centers for Medicare & Medicaid Services (CMS) announced a Proposed Rule titled Medicare Program: Mitigating the Impact of Significant, Anomalous, and Highly Suspect Billing Activity on Medicare Shared Savings Program Financial Calculations in Calendar Year 2023 (CMS-1799-P). While CMS touts this rule as a step forward in addressing billing abuses within the Medicare Shared Savings Program, it raises questions about the agency’s historical efficacy and commitment to combating fraud. The Shared Savings Program is designed to promote accountability for the healthcare of Medicare beneficiaries and encourage efficient service delivery. However, recent trends in billing activities, specifically concerning durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), have prompted concerns about the integrity of financial calculations. In the 2023 calendar year (CY), CMS observed a spike in billing for specific intermittent urinary catheter supplies, identified by HCPCS codes A4352 and A4353. This surge in billing could, if not addressed, distort the accuracy of expenditure and revenue calculations critical to the program.

?? Major Updates for Medicare Advantage: D-SNPs & C-SNPs in 2025! The 2025 Annual Enrollment Period (AEP) is approaching, and there are significant changes coming to D-SNPs and C-SNPs that healthcare professionals and insurers need to be aware of. ?? This detailed article covers: ?? Key regulatory changes ?? How these updates impact plan offerings ?? Strategies to stay ahead in this evolving landscape If you’re working in the Medicare space, understanding these updates is crucial for optimizing your strategy in 2025! Follow Jared Strock for daily insights like this one! ?? Read more here: https://lnkd.in/eEZ2E5zx #MedicareAdvantage #DSNP #CSNP #AEP2025 #HealthcareMarketing #RegulatoryUpdates

MEDICARE ADVANTAGE- - -Of the 66.7 million beneficiaries eligible for Medicare, so far this year 50.8% have a Medicare Advantage (MA) plan, up from 48.8% in April 2023 (based on Centers for Medicare & Medicaid Services/CMS enrollment data). Membership is 33,418,874, a net gain of 2,012,117 over 2023. California, Texas, Florida, and New York saw the most growth, each with increases of 100,000 or more. In a powerful display of market dominance, 10 insurers out of 284 offering MA plans covered just under 80% of all Medicare Advantage enrollees in 2024. ol·i·gop·o·ly = a state of limited competition where control over a sector or industry segment lies in the hands of a few large sellers who own a dominant share of market.

Growing Engagement in CMS' Accountable Care Organization Initiatives for 2024 Exciting developments in healthcare as CMS reports a substantial rise in accountable care engagement for 2024. With 19 new ACOs joining the Medicare Shared Savings Program, receiving over $20 million in advance payments, the total count now stands at 480 active ACOs. This surge is pivotal in delivering coordinated care for approximately 13.7 million Traditional Medicare beneficiaries. CMS's focus on quality, equity, and person-centered care is making a significant impact. Centers for Medicare & Medicaid Services (CMS) just announced exciting changes for 2024, with more ACOs joining. We can guide you through the process, making sure you get the most out of it. Don't miss out—click here to improve your billing now: https://bit.ly/3vXxh7M #ACO #CMS #MBC #RCM #RCMServices #CMSUpdate #MedicalBilling #MedicalCoding #AccountableCareOrganization #RevenueCycleManagement #MedicalBillersandCoders

The Centers for Medicare & Medicaid Services (CMS) finalized the Medicaid Disproportionate Share Hospital (DSH) Third-Party Payer Rule on February 23, 2024. This rule, influenced by the Consolidated Appropriations Act (CAA) of 2021, alters how Medicaid hospital-specific #DSH limits are calculated, particularly concerning third-party payments under section 203 of the CAA. The rule also addresses administrative inefficiencies and offers clarifications on the DSH program. To learn more about the key provisions of the #finalrule, visit our website: https://okt.to/dmXxBE