3+ day, 18+ hour ago   (1387+ words) The CMS released draft star ratings, including the thresholds for reaching those ratings, to plans earlier this week. The grading sheet got stricter, which doesn’t bode well for insurers. Medicare Advantage insurers could see their star ratings fall next year…...

5+ day, 19+ hour ago   (242+ words) The contract lapse comes as the health system and cancer institute are winding down a decades-old partnership. Mass General Brigham Health Plan has announced that it’s eliminating the Dana-Farber Cancer Institute from its Medicare Advantage network Oct. 1. The insurer said…...

6+ day, 7+ min ago   (495+ words) For years, improving Star Ratings often meant adding another quality initiative. Another outreach campaign. Another worklist. Another process designed to improve a specific measure. Today, many Medicare Advantage plans are taking a different approach. Rather than managing quality measure by…...

1+ week, 4+ day ago   (558+ words) Shoddy CMS oversight is to blame, and the agency needs to do better, the HHS Office of the Inspector General said. Medicare Part D isn’t supposed to pay for drugs that can be purchased without a prescription. But the government’s…...

1+ week, 4+ day ago   (599+ words) The codes span a broad range of services across multiple specialties, including oncology and cardiology, orthopedic and musculoskeletal procedures and genetic and lab testing. Providers generally loathe prior authorization, a controversial process requiring them to get an insurer’s OK before…...

1+ week, 6+ day ago   (415+ words) A partnership between rival drug middlemen Prime Therapeutics and Express Scripts depressed reimbursement rates for pharmacies in Florida, according to a new lawsuit. PBMs, influential middlemen in the drug supply chain, contract with payers to provide pharmacy benefits to their…...

2+ week, 4+ day ago   (303+ words) The DOJ told Healthcare Dive that Monogram, a home health company, overcharged Medicare through contracts with Cigna and Humana by inflating diagnostic codes. In Medicare Advantage, the CMS pays private insurers a fixed amount for each member every month, adjusted…...