The Centers for Medicare & Medicaid Services (CMS) is looking to further crack down on the companies that administer the privatized version of Medicare. On Nov. 26, CMS proposed new policies aimed at holding Medicare Advantage (MA) plans more accountable while removing “unnecessary barriers to care” for Medicare beneficiaries. The policies target “inappropriate” prior authorization…
CMS Wants to Prevent ‘Barriers to Care’ in Medicare Advantage Programs, Add Guardrails Around AI
Mobility Management: August 2024 issue
Read about how Medicare Advantage plans are restricting access to Complex Rehab Technology, and why Medicare’s seat elevation coding and allowable decision could deny bariatric wheelchair riders from using these critically important, medically necessary systems. • CRT’s Medicare Advantage Problem • The Clinician Task Force’s Cara Masselink: “There’s a Lot to Protect” • Seat Elevation:…
Case Example: Challenging a Medicare Advantage Denial
Q&A with Noel Neil, JM, CDME, ACU-Serve Corp.
An all-too-common complaint about Medicare Advantage (MA) plans is that they either deny claims that traditional Medicare fee-for-service would have approved, or that they require equipment providers, clinicians and patients to take extra steps to qualify for equipment — additional hoops to jump through that traditional Medicare would not have required. Those additional MA steps…
AAHomecare: UnitedHealthcare’s Medicare Advantage Delay Can Be Learning Opportunity for HME Providers
Implementation has been postponed till Sept. 1.
UnitedHealthcare has delayed implementation of “substantially revised” home medical equipment (HME) order and fulfillment processes linked to Medicare Advantage (MA) plans in Georgia and North Carolina — which can provide a learning opportunity for HME suppliers, according to the American Association for Homecare (AAHomecare). In a July 22 message to members and industry stakeholders, AAHomecare…
Clinician Task Force Survey Focuses on Medicare Advantage Access
The CTF is asking for providers to track and report PWC claims sent to Medicare Advantage plans.
The Clinician Task Force (CTF) is using a survey to collect information on Medicare Advantage (MA) plans in an effort to better understand MA plans’ denials of power wheelchair claims. After entering contact information, survey participants are asked which MA plans they work with. Then participants are asked why they have decided not to work…
Share Your Medicare Advantage PWC Denials with Industry Workgroup
The workgroup is led by the Clinician Task Force and NCART.
If you’re a Complex Rehab Technology (CRT) provider and have had power wheelchair claims denied by one or more Medicare Advantage plans, an industry workgroup wants to hear from you. That’s the message that NCART passed along in its Dec. 28 newsletter to stakeholders. “Improper Medicare Advantage denials of power wheelchairs continue to negatively impact…
Commentary: Seniors at a DISAdvantage Over MA Plans’ Marketing
Medicare Advantage plans' outreach seems confusing by design.
On a typical work day, I receive several robocalls from Medicare Advantage (MA) plans wanting to ask “a few simple questions” to see if I qualify. I usually just hang up, but recently I was particularly cranky about being interrupted. So I told the robo-voice I did not have Medicare Part A or B, which…