Sharon Musso

CMS ENCOURAGES MEDICARE ADVANTAGE PLANS TO USE GOLD CARDING TO ALLEVIATE PRIOR AUTHORIZATION BURDEN ON PROVIDERS

Gold carding programs are programs that eliminate or reduce prior authorization requirements for providers whose requests for prior authorization have consistently been approved and/or who have met other evidence-based criteria. In its recently published proposed rules for Medicare Advantage plans for the 2024 contract year, CMS encouraged Medicare Advantage Plans to implement gold carding programs, …

CMS ENCOURAGES MEDICARE ADVANTAGE PLANS TO USE GOLD CARDING TO ALLEVIATE PRIOR AUTHORIZATION BURDEN ON PROVIDERS Read More »

NEW REPORT FINDS MEDICARE ADVANTAGE PLANS MORE LIKELY TO DENY INPATIENT CLAIMS THAN OTHER PAYERS

A new report released by Crowe, LLP found that Medicare Advantage plans are much more likely than other payers to deny payment for inpatient claims. The report, entitled “Who’s picking up the check,” analyzed data from more than 1,700 hospitals. It found that Medicare Advantage plans denied 5.8% of inpatient admissions in 2022 compared to …

NEW REPORT FINDS MEDICARE ADVANTAGE PLANS MORE LIKELY TO DENY INPATIENT CLAIMS THAN OTHER PAYERS Read More »

UNITEDHEALTH GROUP REPORTS STRONG PROFITS FOR THE THIRD QUARTER OF 2022, BEATING ANALYSTS’ EXPECTATIONS

UnitedHealth Group (“United”) reported strong profits for the third quarter of 2022, with double-digit growth at both UnitedHealthcare and Optum. United’s strong third quarter profits beat analysts’ expectations and prompted UnitedHealth Group to increase its earnings forecast for the year. United posted profits of $5.3 billion for the third quarter, up from $4.1 billion for …

UNITEDHEALTH GROUP REPORTS STRONG PROFITS FOR THE THIRD QUARTER OF 2022, BEATING ANALYSTS’ EXPECTATIONS Read More »

NY ATTORNEY GENERAL SUES CVS, ALLEGING THAT IT HARMS SAFETY NET HOSPITALS AND PATIENTS BY DIVERTING MILLIONS FROM UNDERSERVED COMMUNITIES TO CVS

New York’s Attorney General, Letitia James, has sued CVS Health Corp., alleging that it violated New York’s antitrust laws and abused its market power by illegally requiring safety net hospitals that contract with CVS pharmacies for dispensing 340B outpatient drugs to exclusively use CVS’s subsidiary Wellpartner as their Third Party Administrator (“TPA”) for the 340B …

NY ATTORNEY GENERAL SUES CVS, ALLEGING THAT IT HARMS SAFETY NET HOSPITALS AND PATIENTS BY DIVERTING MILLIONS FROM UNDERSERVED COMMUNITIES TO CVS Read More »

THE SUPREME COURT SUPPORTS HHS’S RULES GOVERNING CALCULATION OF DSH ADJUSTMENTS TO HOSPITALS SERVING LOW-INCOME PATIENTS

On June 24, 2022, in Becerra v. Empire Health Foundation, the Supreme Court upheld the Department of Health and Human Services’ interpretation of the Medicare statute governing how disproportionate share adjustments are calculated for hospitals serving low-income patients. The interpretation upheld by the Court generally reduces the payments available to these hospitals. The case involved …

THE SUPREME COURT SUPPORTS HHS’S RULES GOVERNING CALCULATION OF DSH ADJUSTMENTS TO HOSPITALS SERVING LOW-INCOME PATIENTS Read More »

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