Medicare Advantage and Part D

From Medicare Advantage News - The Indiana Dept. of Administration on June 10 unveiled its intent to award Medicaid managed care contracts to four out of the five insurers that responded to a request for proposals, rejecting a bid from UnitedHealthcare unit UnitedHealthcare Community Plan. One of several Republican-led states to expand their Medicaid programs last year under terms of the Affordable Care Act (MAN 2/12/15, p. 5), Indiana will transition care from three to four insurers effective Jan. 1, 2017. Read more

From Medicare Advantage News - In a highly critical report posted May 9, the Government Accountability Office (GAO) calls out CMS for underdelivering on its risk adjustment data validation (RADV) audits, which in theory should spur CMS to begin collecting overpayments based on extrapolated audit findings and comply with an Affordable Care Act (ACA) mandate to establish recovery audit contractors (RACs) for the Medicare Advantage program. Read more

Medicare Advantage & Part D Blog

By Lauren Flynn Kelly - July 14, 2016
At sessions of the 12th Annual Government Health Care Congress held July 12 and 13 in Tysons Corner, Va., two central themes rang out: integration and value. Whether it comes to coordinating post-acute care for seniors enrolled in Medicare or meeting the more complex needs of the dual-eligible...
By Lauren Flynn Kelly - June 16, 2016
When Medicare accountable care organizations and the Medicare Shared Savings Program (MSSP) were established in 2011 as a result of the Affordable Care Act, some industry observers predicted a large-scale movement of ACOs building their own risk-bearing entities and forming their own Medicare...
By Lauren Flynn Kelly - May 23, 2016
A year-and-a-half ago, CMS backed off a proposal pertaining to direct and indirect remuneration and pharmacy price concessions in an effort to further clarify the types of DIR fees charged to pharmacies participating in Part D networks that should be included in the negotiated price of a drug...

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