‘Patients Hung Out To Dry’: Report Shows Insurers Significantly Increase Rate Of Denials For Post-Acute Care

The Senate Homeland Security Permanent Subcommittee on Investigations (PSI) released a report on Thursday revealing that the nation’s three largest Medicare Advantage (MA) insurers have significantly increased the rate at which they denied seniors’ post-acute care from 2020 to 2023. This includes denying access to nursing homes, inpatient rehabilitation facilities and long-term acute care hospitals. […]

‘A Deteriorating Industry’: What Home Health Provider Margins Actually Look Like

The Medicare Payment Advisory Commission (MedPAC) paints a rosy portrait of home health margins. But an analysis of cost reporting data – that considers both traditional Medicare and Medicare Advantage (MA) payments – shows that providers are generally not sitting atop a hill of money. Instead, they are struggling to stay above water. Kalon Mitchell […]

Medicare Advantage Penetration Expected To Continue In 2025

Despite multiple large insurers pulling back on Medicare Advantage (MA), about 51% of Medicare beneficiaries are expected to be enrolled in an MA plan come 2025. The Centers for Medicare & Medicaid Services (CMS) has created a less rosy payment environment for MA plans over recent years, and that has forced some plans to exit […]

More Home Health Providers Sunset Relationships With Largest Medicare Advantage Payers

Essentia Health – a regional, nonprofit health system with a substantial home health arm – announced this week that it will no longer serve as an in-network provider for UnitedHealth Group (NYSE: UNH) and Humana Inc. (NYSE: HUM) Medicare Advantage (MA) plans. It is the latest example of home-focused health care providers drawing a line […]

For Home Health Providers, Getting The ‘Right Person’ At The Table Is Crucial In Medicare Advantage Negotiations

While getting a fair rate is top of mind for home health providers, the ones that are seeing the most success in their negotiations with Medicare Advantage (MA) payers are selling their ability to be a solution. Even before entering negotiations with MA plans, providers should have a clear understanding of the challenging reimbursement environment […]

Medicare Advantage Plans Are Contracting Heading Into 2025

Humana Inc. (NYSE: HUM) will be exiting 13 Medicare Advantage (MA) markets in 2025, company leaders said during the Wells Fargo Healthcare Conference. The company had already announced that it was planning to leave markets next year, but offered up more specifics last week. Humana CFO Susan Diamond said the company’s exit from those 13 […]

How CenterWell Can Prove Home Health Care’s Worth Within Humana

Earlier this year, I had the chance to interview CenterWell President Sanjay Shetty on stage and off stage at the Digital Healthcare Innovation Summit in La Jolla, California. Last month, at Home Health Care News’ FUTURE conference in Nashville, I did the same with Kirk Allen, the president of home solutions at Humana Inc. (NYSE: […]

SDoH-Related Unhealthy Days Lead To Higher Health Care Costs For Medicare Advantage Plans

When examining a Medicare Advantage (MA) population, one unhealthy day was enough to increase 30-day medical costs, a new study found.  The study sought to examine the connection between self-reported physically and mentally unhealthy days and health care costs among an MA population. One of the driving forces behind the study was Papa, a company […]