Medicare Advantage

Anybody There? Physicians Unfairly Penalized for AWOL Medicare Advantage Patients - 09/04/2019

You’ve tried and tried and tried. Phone calls, emails – nothing. A Medicare Advantage plan assigned you a patient who didn’t choose you, and the patient is driving that point home – by ignoring you. Or maybe the contact information the plan gave you is out of date, and the patient’s latest phone number or email is unknown. Either way, your as-yet-unseen patient is AWOL – and you can be penalized for it on health plans’ quality ratings, which ultimately can affect payments. New Texas Medical Association policy takes aim at the unfairness this lack of patient response can present for physicians, while opening up an opportunity for medicine to work with health plans to solve the problem.


Medicine to Feds: Back Off Prior Authorization Requirements - 03/07/2019

The Texas Medical Association, American Medical Association, and a host of other medical societies are trying to stop onerous, care-impeding prior authorization requirements from overrunning Medicare Advantage plans.


Help Your Medicare Patients Keep Their Favorite Doctor (You) - 11/28/2018

Medicare’s open enrollment runs through Dec. 7, and some of your patients might be evaluating their plan options. Do they know what plans you take?


TMA asks CMS to Prohibit Step Therapy in Medicare Advantage - 11/16/2018

Step therapy protocols “can both harm patients and undercut the physician-patient decisionmaking process,” the Texas Medical Association said in a letter urging the Centers for Medicare & Medicaid Services (CMS) to reconsider its recent decision to allow step therapy in Medicare Advantage plans.


Amerigroup to Conduct New Post-Payment Reviews - 05/30/2018

Amerigroup has begun conducting post-payment reviews of certain claims billed with modifiers for distinct procedural services. The reviews apply only to Medicare Advantage and Medicare supplement professional claims.


Federal Court Order Blocks Aetna-Humana Merger - 01/31/2017

U.S. District Judge John Bates sent a clear message last month when he issued an order imposing an injunction on Aetna's $37 billion acquisition of Humana, which focused largely on buying up Humana's Medicare Advantage business. The judge found the merger would "be likely to substantially lessen competition" in the Medicaid Advantage market. Indeed, it would have a significant impact across Texas — and 13 other states — likely enhancing Aetna's market power to concerning levels per the federal government's own standards, according to a comprehensive American Medical Association analysis.


DOJ Sues to Block Health Insurer Mergers - 10/10/2016

Two potential health plan mergers have come under intense fire. Last month, the U.S. Department of Justice (DOJ), acting under the direction of the U.S. Attorney General and the states of Delaware, Florida, Georgia, Illinois, Iowa, Pennsylvania, Virginia, and Ohio, as well as the District of Columbia, brought a civil antitrust action to prevent the Aetna-Humana merger from going through. The government also sued to enjoin Anthem from acquiring Cigna. TMA and organized medicine have been scrutinizing the proposed mergers, which physicians say would profit insurers while leaving doctors and patients with fewer choices and higher costs. Aetna seeks to acquire Humana Inc. in a $37 billion deal focused largely on buying up Humana's Medicare Advantage business, while Anthem Inc. looks to take over Cigna for $50 billion.


Medicare Advantage Plans - 05/06/2016

More than ten million Medicare beneficiaries currently receive their Medicare coverage through Medicare Advantage (MA); a program in which Medicare contracts with and pays private health plans to provide coverage for Medicare benefits.