Medicare Advantage Encounter Data Show Promise for Program Oversight, But Improvements Are Needed. Office of the Inspector General; 2018. 25. Meyers DJ, Rahman M, Rivera-Hernandez M, Trivedi AN, Mor V. Plan switching among Medicare Advantage beneficiaries with Alzh...
an Advantage plan refused to approve a follow-up MRI to determine whether a lesion was malignant after it was identified through an earlier CT scan because the lesion was too small. The plan reversed its decision after an appeal, theNew York Timesreported. ...
Without adequate cybersecurity, networked medical devices can be hacked and cause harm to patients. The growing number of cyberattacks in the healthcare sector pose a real threat, which is why it is crucial that AOs increase accountability and monitor medical device cybersecurity,...
“a direct or indirect effect of creating an incentive that would reasonably be expected to inhibit an agent or broker's ability to objectively assess and recommend which plan best fits the health care needs of a beneficiary.” It is unclear how CMS intends to enforce this prohibition...
The Inflation Reduction Act (IRA) significantly changed the popular Medicare drug programs. While an IRA policy goal is to reduce the out-of-pocket drug spending, beneficiaries may experience higher drug plan premiums and...more Affordable Care Act Section 1557 New Language Accessibility Requirements...
The findings are based on a comparison of the rates the plans reported to the government's Healthcare Effectiveness Data and Information Set (HEDIS) for 2006 and 2007 with rates the researchers calculated for each plan during the same years, using data from Medicare Part D drug claims. The ...
But Erin Fuse Brown, a professor at the Brown University School of Public Health, said the decision reflects a pattern of timid CMS oversight of the popular health plans for seniors. "CMS saving money for taxpayers isn't enough of a reason to face the wrath of very powerful health plans,...
Strengthen plan oversight Strengthen marketing protections Ensure parity between mental health and physical health coverage Ensure the Medicare appeals system is cost-effective, accessible and fair 2. Reduce Ongoing Barriers to Care Eliminate the harm of hospital “Observation Status” ...
A.H. designed and executed the analysis plan with supervision from Caroline Pearson. D.M. drafted the manuscript with oversight from Caroline Pearson. James Beck, Veronica Todaro, Allison Willis, and Rachel Dolhun supervised the analysis, interpretation, and drafting. Corresponding author ...
These entities that provide investigation and oversight related to potential fraud include the Medicaid Fraud Control Units, or MFCUs, which operate in 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands.2Most MFCUs operate as part of the Attorney General’s office ...