The CMS is proposing a modest increase in baseline Medicare Advantage payment rates for 2018 of 0.25% on average, down from 0.85% last year.
Nearly half of the provider directories of Medicare Advantage plans reviewed by the CMS are incorrect, the agency said.
The Medicare Payment Advisory Commission Thursday approved measures to increase payments to Medicare Advantage plans, potentially increasing federal spending by as much as $10 billion over five years.
While Medicare Advantage plans added nearly 900,000 members in 2016, enrollment is growing at a slower pace. Still, experts say the future of Medicare Advantage will be lucrative for insurers.
Several top federal Medicare leaders have taken new roles just months before Donald Trump assumes the presidency.
If Congress passes the 21st Century Cures Act, the federal government would be barred from axing the worst performers in Medicare Advantage through 2018.
Major changes in the exchange-based individual market will spill over to Americans with practically any type of health coverage—Medicare, Medicaid or employer-based plans.
Dale Maxwell will become interim CEO at Albuquerque-based Presbyterian Healthcare Services when current president and CEO James Hinton leaves to become chief executive at Dallas-based Baylor Scott & White Health in January 2017.
The CMS has temporarily stopped accepting new proposals from health insurance companies seeking to enroll their commercial or Medicaid patients automatically into their Medicare Advantage plans.
The percentage of Humana Medicare Advantage members in plans with four stars or higher fell by half, from 78% a year ago to 37%. Cigna has only 20% of its members in plans rated four stars or higher. Meanwhile, 91% of Aetna's members are enrolled in four-star plans.
Doctors say they're losing patients when commercial health plans automatically move consumers over to a Medicare Advantage plan when they turn 65. The MA plans mean more revenue for insurers, but it often means patients' usual doctors will be considered out of network.
Healthcare organizations that run afoul of federal regulations will be paying heftier penalties, due to updates made by HHS last Friday that factor in multiple years of inflation.