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News
29 Health Systems Dropping Medicare Advantage Plans
4+ day, 10+ hour ago (872+ words) The number of terminated contracts this year is down from 40 in 2025 and 32 in 2024, Becker’s Hospital Review reported on Sept. 4. Naples Comprehensive Health, one of the top 50 U.S. hospitals, will go out of network with Centene’s Wellcare and Health Care Service…...
How Medical Denial Management Actually Works (And Why Most Practices Get It Wrong)
7+ hour, 3+ min ago (31+ words) Claim denials cost healthcare practices more than most providers realize — not just in lost revenue, but in staff …...
157 Lab Providers Lost Medicare Billing Privileges—Here’s Why Checking Your Medicare Statement Matters
2+ day, 9+ hour ago (192+ words) According to CMS, those systems look for abnormal combinations involving testing, results, billing, documentation, and relationships that could indicate fraud, waste, or abuse. The technology can help flag high-risk claims for additional review and potentially allow claims to be held,…...
Medicaid Risk Contracts in New ACO LEAD Model
2+ day, 9+ hour ago (223+ words) Integrated care programs for dual-eligible beneficiaries, including ACO LEAD, aim to incentivize efficient care delivery while preventing unintended cost shifting between Medicare and Medicaid. How LEAD calculates shared savings and losses will be central to achieving both goals. First, a…...
Advantage Plans Said No 4.1 Million Times in 2024. Four in Five Appeals Won. Nine in 10 Denials Were Never Appealed.
2+ day, 11+ hour ago (629+ words) Medicare Advantage plans denied millions of prior authorization requests last year, and most patients accepted that answer without a fight. What happened to the ones who pushed back reveals something uncomfortable about how those first decisions get made. The Full…...
How to bridge insurance coverage gaps & save on prescriptions
3+ day, 8+ hour ago (40+ words) Yahoo Divya Iyer, Consumer Healthcare Expert and Senior Vice President at GoodRx, joined us to discuss how rising out-of-pocket costs and deductibles leave many insured Georgians facing health insurance coverage gaps....
A Vision for Modernizing Medicare Risk Adjustment: Building the Evidence for Reform
3+ day, 7+ hour ago (231+ words) Margolis Institute for Health Policy A Vision for Modernizing Medicare Risk Adjustment: Building the Evidence for Reform Medicare Advantage (MA) is the largest source of Medicare coverage for seniors today and continues to grow. The most important payment policy underpinning…...
A Medicare policy designed to encourage certain business arrangements produced unexpected results
3+ day, 10+ hour ago (393+ words) "The exclusion bar can be for the rest of your lifetime or for several years, but it effectively halts your ability to participate," said Alice Harris. Terry Gerton The Health and Human Services Department recently delegated one of its powers…...
There Is No Medicare Appeal When a Medigap Insurer Says No at 72. No Federal Form, No Hearing, Just the Next Company’s Application.
3+ day, 11+ hour ago (744+ words) When a Medigap insurer declines your application at 72, the federal appeals process that protects Medicare Advantage enrollees simply does not exist here, and the path forward depends on a sequence most applicants get dangerously wrong. The Full Benefits Desk desk....
You Picked the Plan Because Your Doctor Was in the Directory. Federal Auditors Found More Than Half the Listed Mental-Health Providers Weren't Seeing Patients.
4+ day, 7+ hour ago (735+ words) Federal auditors spent months calling the therapists listed inside Medicare Advantage directories, and what they found on the other end of the line raises serious questions about whether the coverage you enrolled in actually exists. The Full Benefits Desk desk....