We have several updates from the Medicare Advantage market this week. We are reading updates on the ruling in the UHC case on the Medicare Advantage overpayment rule, details on how 5,000 Medicare Advantage patients have lost access to their in-network provider, and how partnerships between payers and providers are creating new Medicare Advantage options.
In big payer win, court sides with UnitedHealth on MA overpayment rule | HealthcareDive | September 10, 2018
- A federal district court judge on Friday sided with UnitedHealthcare-led payers in a case that challenged a CMS Overpayment Rule from 2014.
- Judge Rosemary Collyer vacated the rule, which the payers charged created additional burdens for Medicare Advantage insurers that are not consistent with traditional Medicare regulations.
- The judge wrote that CMS doesn’t see more errors or fraud in MA beneficiary charges than those in traditional Medicare. However, the overpayment rule may result in payers getting lower reimbursements while providing the same level of healthcare coverage.
5,000 Medicare patients say they suddenly lost access to their doctors | KXAN – Austin | September 13, 2018
About 5,000 Medicare Advantage patients in Central Texas say they’ve suddenly been cut off from their go-to doctors.
Austin Regional Clinic told us they knew they wouldn’t be an in-network provider with United Healthcare for Medicare Advantage patients beginning next year.
ARC expanded some programs, and those changes led to ARC and United Healthcare respectfully and mutually deciding to end their contract.
United Healthcare told us ARC providers remain in their network and are available through their directories for the remainder of the 2018 year.
Payers, Providers Create New Medicare Advantage Partnerships | HealthPayer Intelligence | August 24, 2018
New Medicare Advantage plans, many born of innovative partnerships between payers and providers, are creating more options for beneficiaries to supplement their existing coverage with high-value offerings.
Commercial payers operating in the $187 billion Medicare Advantage market are developing plans tailored to aging members with rising risks for chronic diseases and an enhanced need for coordinated, comprehensive care.
The latest activities from some of the nation’s largest commercial insurers indicate that new provider partnerships, network extensions, and additional benefits are just a few ways that payers hope to enhance Medicare Advantage value.