Christina Bessette

June 3, 2021

Bill Introduced in Congress to Limit Medicare Advantage Prior Authorization

Bill Introduced in Congress to Limit Medicare Advantage Prior Authorization On May 21, 2021, House Bill 3173 (117th Congress), which seeks to cut red tape on prior authorizations in Medicare was introduced. The bill would require Medicare Advantage plans to report approval and denial rates. The bill was introduced by Representative Larry Buchon, MD, and would require Medicare Advantage insurers to be more clear about their prior authorization policies, according to a group of House members. H.R.3173 would establish an electronic prior authorization process and would require the Department of Health and Human Services to create a process for real-time decisions for items and services routinely approved. It would require Medicare Advantage plans to report on their use of prior […]
June 3, 2021

CMS Inspector General Find Millions in Overpayment to Anthem Health Care

CMS Inspector General Find Millions in Overpayment to Anthem Health Care On May 24, 2021, CMS’ Inspector General announced a finding that health insurer Anthem failed to comply with some federal coding requirements, resulting in overpayments to Anthem of $3.47 million.  Under the Medicare Advantage program, CMS makes monthly payments to organizations according to a system of risk adjustment determined by the health status of each enrollee. CMS relies on Medicare Advantage insurers to collect diagnosis codes from providers and submit them to CMS. Some of the diagnoses are at a higher risk of being miscoded.  For the audit, CMS sampled 203 unique enrollee-years from Anthem and focused on seven groups of high-risk diagnosis codes to determine whether the codes […]
June 3, 2021

U.S. Department of Health and Human Services Announces Several New Appointments

U.S. Department of Health and Human Services Announces Several New Appointments On May 25, 2021, the U.S. Department of Health and Human Services announced 15 new appointments: 1. Steve Cha, MD, was named counselor to the secretary, Agency for Healthcare Research and Quality/Food and Drug Administration/National Institutes of Health. 2. Melanie Fontes Rainer was named counselor to the secretary, Affordable Care Act/marketplaces/Office for Civil Rights/Center for Medicare & Medicaid Innovation. 3. Steven Lopez was named counselor to the secretary, Equity/Office of the Assistant Secretary for Health/Health Resources and Services Administration/Indian Health Service. 4. Ben Scott was chosen as advance representative in the Office of the Secretary. 5. Josie Villanueva Prescott was chosen as counselor to the secretary, Administration for Children […]
June 3, 2021

Two Reports on Health Care Trends Released

Two Reports on Health Care Trends Released The American Medical Associaion released two separate reports on health care trends in May. The first report was on 2019 health care spending. This report provides a detailed look at the official U.S. health care spending estimates through 2019 using data from the CMS. It also presents preliminary estimates of 2020 health spending from Altarum, a private research organization that focuses on health policy. Health spending was 17.7% of GDP in 2019 and increased by 4.6% from 2018 spending to $3.8 trillion ($11,582 per capita). Spending in hospital care (6.2%) and prescription drugs (5.7%) grew faster than physician services (4.2%) in 2019. In 2019, spending growth in Medicare (6.7%) and out-of-pocket payments (4.6%) […]