RADAR on Medicare Advantage

  • In AEP Home Stretch, MAOs Make Final Push for Enrollment

    With a bevy of plan options and supplemental benefits available to seniors and the omnipresence of multicarrier brokers, regional Medicare Advantage organizations are working doubly hard to get in front of potential and existing customers during this final stretch of the 2022 Annual Election Period (AEP). Complicating their efforts are continued slowdowns with mail delivery, which could impact brochures getting to Medicare-eligible beneficiaries before the AEP ends on Dec. 7, according to marketing experts.
  • Expecting Hot Medicare AEP, E-Brokers Beefed Up Internal Sales Forces

    As the Medicare Annual Election Period (AEP) was in full swing last month, electronic marketing organizations (EMOs) like eHealth, Inc. and GoHealth, Inc. saw increased traffic to their online marketplaces and improved use of other digital tools. But both publicly traded firms, which posted third-quarter 2021 earnings in early November, have reported trouble converting telesales into enrollments and retaining members from the prior year — an area that is often seen as a weak spot for carriers that work with the large brokers.
  • Recent MA Coding Complaints Signal DOJ’s ‘Evolving Expectations’

    The risk adjustment system used to pay Medicare Advantage plans continues to face intensifying scrutiny from the federal government, with the Dept. of Justice (DOJ) intervening in multiple False Claims Act (FCA) complaints and the HHS Office of Inspector General focusing on retrospective chart reviews and high-risk diagnosis codes. Now, attorneys say health care providers should be on high alert as well. While prior DOJ complaints-in-intervention have focused largely on MAOs conducting “one-way” chart reviews, more recent lawsuits focus on the use of “addenda” — information retroactively added to a patient’s medical record — which one law firm says indicates a new area of scrutiny.
  • As Supplemental Benefits Rise, In-Home Services Skyrocket in ’22

    CMS’s reinterpretation of “primarily health-related” benefits has led to more Medicare Advantage plans offering services such as in-home support services, home-based palliative care, support for caregivers and therapeutic massage for the upcoming plan year, according to a new analysis from Milliman. The number of MA plans that will offer one of five selected benefits grew 43% from 2021, to 824 plans, while 202 plans will offer at least two of the benefits next year, up from 175 plans in 2021. Notably, the number of plans offering in-home support skyrocketed from 296 in 2021 to more than 500 in 2022. Of the five studied benefits, only adult day health services will see a decline in availability next year.
  • Latest OIG Risk Adjustment Audit Seeks $6.4 Million From UPMC

    Continuing a series of audits in which the HHS Office of Inspector General is reviewing the accuracy of diagnosis codes submitted to CMS by Medicare Advantage organizations, OIG last month said most of the codes it reviewed for UPMC Health Plan, Inc. could not be validated by medical records. The agency used its own extrapolation methodology to estimate that the Pittsburgh-based insurer owes $6.4 million for the 2015 and 2016 payment years, prompting a detailed rebuttal from UPMC and adding to the ongoing debate over the use of sampling to approximate a plan’s true payment error rate.
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