CMS Seeks Feedback to Improve Medicare Advantage Plans

Published in Complex Rehab 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

Embracing Change: Our Journey Toward Diversity, Equity, and Inclusion thumbnail Embracing Change: Our Journey Toward Diversity, Equity, and Inclusion Diverse, equitable, and inclusive companies are better able to respond to challenges, attract top talent, and meet the needs of different customer bases. Soft vs. Hard Skills for Today thumbnail Soft vs. Hard Skills for Today No matter how they were looked at in the past, having people with good soft skills has always been as important to your profit as understanding your billing system. Unlocking the Future: Recruiting and Retaining the Next Generation of Talent thumbnail Unlocking the Future: Recruiting and Retaining the Next Generation of Talent Recruiting and retaining a younger generation of employees is a critical challenge for organizations seeking to stay competitive and innovative in today's rapidly evolving business landscape. Preventing Pressure Injuries: Your Guide to Pressure Injury Prevention Month thumbnail Preventing Pressure Injuries: Your Guide to Pressure Injury Prevention Month November is a significant month for healthcare professionals and caregivers around the world as it marks Pressure Injury Prevention Month, particularly on 2023 Worldwide Pressure Injury Prevention Day (November 16). Nurturing a Resilient Organizational Culture for Remote and Diverse Teams thumbnail Nurturing a Resilient Organizational Culture for Remote and Diverse Teams As business leaders, cultivating a strong and vibrant organizational culture across remote and diverse teams is essential for driving success and employee engagement. Revolutionizing Mobility: Dr. Pooja Viswanathan, Tyler Mahncke, and Reliable Medical Supply on the Future of Smart Wheelchair Technology thumbnail Revolutionizing Mobility: Dr. Pooja Viswanathan, Tyler Mahncke, and Reliable Medical Supply on the Future of Smart Wheelchair Technology In today's episode, Tyler Mahncke, V.P of U.S. Rehab, sits down with one of the top complex rehab technology providers in the U.S., along with Dr. Viswanathan, Founder and CEO of Braze, as they share stories about the success of this growing smart technology for power and manual wheelchairs. U.S. Rehab Announces Retirement of Greg Packer thumbnail U.S. Rehab Announces Retirement of Greg Packer Greg Packer of U.S. Rehab has announced his retirement as president, effective at the end of 2023. From Dreams to Life-Changing Beds: Tyler Mahncke, V.P of U.S. Rehab Chats with the CEO of Cubby Beds thumbnail From Dreams to Life-Changing Beds: Tyler Mahncke, V.P of U.S. Rehab Chats with the CEO of Cubby Beds In today's episode, Tyler Mahncke, V.P of U.S. Rehab, sits down with Caleb Polley, the CEO of Cubby Beds, one of the most innovative and fastest growing companies in CRT, as they share stories about the success of their life-changing bed solution for children with special needs.