Maintaining a place in a Medicare Advantage payer’s network requires far more than signing an agreement. Providers need to demonstrate reliable access, quality outcomes and a willingness to work with plans on an ongoing basis — increasingly through timely performance data and regular communication, industry experts said during PAYER Summit in June. “I often see […]
Medicare Advantage (MA) beneficiaries used fewer home health services than their fee-for-service counterparts in 2023, prompting Medicare Payment Advisory Commission (MedPAC) commissioners to ask whether MA plans are limiting access to necessary post-acute care. For beneficiaries who used home health, MA enrollees had 12 annual home health visit-days compared with 15 visit-days for fee-for-service beneficiaries, […]
Economic downturns can prompt states to restrict home- and community-based services (HCBS), but could prompt states to pursue value-based contracts with providers. State Medicaid programs could consider these value-based arrangements over exclusive cuts or benefit reductions, said industry leaders speaking at Home Health Care News’ PAYER Summit in June. “Everyone right now should be a […]
Medicare Advantage, Medicaid managed care and federally facilitated ACA Marketplace health plans deny between 12% and 18% of standard prior authorization requests — denials that can act as a burden to home health providers. Prior authorization denial rates varied widely among the largest insurers in 2025, according to a recent study by KFF. “Health insurers […]
Home-based care providers have long looked to both the Centers for Medicare & Medicaid Services (CMS) and Medicare Advantage (MA) to push forward value-based care, but that balance may be shifting. CMS is driving value-based care growth more than MA, as federal models such as home health value-based purchasing (HHVBP) and the Transforming Episode Accountability […]
Choice Health at Home’s CEO, David Jackson, envisions his rapidly-growing business as among the largest home-based post-acute care businesses within the next five years. To achieve this goal, Jackson has laid out a strategy that includes “matching the market” in terms of Medicare Advantage, a hub-and-spoke density model and a three-pronged service foundation, according to […]
Medicare Advantage (MA) is at an inflection point, prompting home-based care providers to rethink how they grow and whom they contract with. Plans and providers both need to adapt to changing MA trends, according to experts at Home Health Care News’ PAYER Summit. For providers, that could mean prioritizing collaborative payer relationships and, in some […]
At last week’s PAYER Summit, providers, policy experts and payer execs were largely aligned on what will separate successful home-based care organizations from the rest of the pack. Discussions at the event, hosted by Home Health Care News and Skilled Nursing News, included commentary on some notable changes in the payment landscape that have occurred […]
The theme of this week is payment. First, I’ve been paying close attention to a recent investigation by the Office of the Inspector General, which found that the three largest Medicare Advantage organizations (MAOs) denied post-acute services at higher rates than their smaller peers. Even more interestingly, MAOs collectively overturned 36% of long-term care hospital […]
Home-based care providers are feeling the squeeze from Medicare Advantage and Medicaid — and some are responding by limiting admissions for certain payers. When it comes to Medicare Advantage, providers experience a range of pains beyond just rates, including administrative burden, prior authorization delays and care denials and appeals. That’s according to a survey conducted […]
