The Medicare Secondary Payer law rendering a potential $1,000 per day penalty for noncompliance against primary payers has finally been demystified to some extent. The proposed regulation issuing guidance about Medicare Secondary Payer Civil Monetary Penalties relative to Section 111 reporting was unoffi...
I don’t disagree, but I think that’s a secondary concern. The real problem is that government spending will become an ever-larger economic burden. And that will hinder growth whether it’s financed by borrowing or taxes. Speaking of taxes, here’s the chart from the study that deserves...
Now, as brokerage leaders increasingly interface with seasoned payer executives, they face expectations to elevate their performance standards. Potential for rules that set compensation guardrails may necessitate new approaches Less oriented around membership growth, many payers leaned into a proposed rule ...
The agency has also issued more strict prior authorization rules this year and cracked down on when MA plans must cover inpatient care. The health insurance industry has said the new rates will “put even more pressure on the benefits and premiums” of MA beneficiaries, a warning that ...
Excellent, excellent point. Kind of digging a little bit deeper on the diagnosis codes and how things are the focus and the concerns by the government. If you have diagnoses that are listed, right, primary, secondary, et cetera, but there’s no treatment for those diagnoses or if you have...
Payer considerations in 2024 as Medicare Advantage changes Sweeping changes to Medicare Advantage: How payers could respond As the MA market shifts, brokers face beneficiary churn, payers’ vertical integration, and compensation uncertainty. To survive, they’ll need to expand services and professionalize...