CMS Seeks Feedback to Improve Medicare Advantage Plans

Published in Member Communities on August 03, 2022

Dan FedorOn the heels of the OIG report issued on April 28, 2022 regarding how Medicare Advantage (MA) Plans have denied approximately 13% of claims for coverage that traditional Medicare would have paid and 18% of claims for billing rules, CMS issued a notice seeking feedback to improve MA plans on July 28, 2022. 

How can these MA plans improve? It's easy. Just follow the published traditional Medicare coverage and billing rules 100%. Many of these plans verbally state "we follow Medicare," but in fact, we have all seen that they don't, and trying to resolve a denial is extremely challenging as they don't make it easy (seems to be by design). With suppliers running lean due to the labor shortages, increase in cost of goods with no proportional increase to the payment rates, many suppliers don't have the resources to fight inappropriate denials and just give up. This is an unsustainable business model with unintended consequences of access issues for Medicare beneficiaries. 

I understand you all are busy, but please take the time to give your feedback to this request by August 31, 2022. We at VGM and U.S. Rehab plan to submit feedback as well. This is our chance to further expose the impact these MA plans are having on the industry and how it is negatively impacting Medicare beneficiaries who are finding out that some of the plans are not "Dyn-O-Mite."

Click here to submit your feedback.

Click here to read the press release.

Click here to read the OIG report.

Dan Fedor
Director, Reimbursement and Education


TAGS

  1. billing & reimbursement
  2. cms
  3. medicare
  4. reimbursement

From Our Experts

VGM Playbook: Technology-Driven Strategies and Resources Now Available thumbnail VGM Playbook: Technology-Driven Strategies and Resources Now Available “VGM Playbook: Technology-Driven Strategies and Resources” is designed to help VGM members harness the power of technology and artificial intelligence (AI). Building a Better Tomorrow thumbnail Building a Better Tomorrow As the fall colors begin to paint the landscape, it's a time to reflect on what we've achieved and the challenges we've overcome in 2025. This year has brought transformation to the home accessibility industry while continuing to meet the growing needs of our aging population. However, the journey has not been without hurdles. O&P Legislation: A Bill Where All Parties Benefit thumbnail O&P Legislation: A Bill Where All Parties Benefit Recent fraud takedown will fuel support for O&P legislation, stakeholders say. Live at Home Sees Spike in Interest in Home Access Market thumbnail Live at Home Sees Spike in Interest in Home Access Market VGM Live at Home's Cindi Petito is noticing increased interest in the home accessibility market in the wake of CMS's decision to resurrect competitive bidding. Meet The 2025 O&P Woman of the Year, Fanny Schultea thumbnail Meet The 2025 O&P Woman of the Year, Fanny Schultea OPGA is proud to announce that Fanny Schultea, MS, MSEd, CPO, LP, FAAOP, Executive Director of The Orthotics and Prosthetics Foundation for Education and Research, has been selected as the 2025 O&P Woman of the Year. Setting Up Your HME for Enrollment Success thumbnail Setting Up Your HME for Enrollment Success Unlock enrollment success for your HME business with tips on provider enrollment, CMS compliance, and avoiding pitfalls. Stay prepared and compliant. September Shift: From Busy to Better—Owning the Home in HME thumbnail September Shift: From Busy to Better—Owning the Home in HME Discover how HME providers can shift from busy to better this September. Learn strategies for enhancing patient experiences, improving operational efficiency, and navigating payer complexities. Join us in building lasting customer relationships and fostering community engagement for a successful Q4 and beyond. The Role of DMEPOS in Value-Based Healthcare thumbnail The Role of DMEPOS in Value-Based Healthcare Explore how DMEPOS providers contribute to value-based care by enhancing patient outcomes, reducing costs, and promoting healthcare transformation.