Quest Analytics to Measure Adequate Access to Care for Medicare Advantage, Medicare-Medicaid and Pharmacy Plans
OVERLAND PARK, KS, September 15, 2020 – Quest Analytics, the leader in provider network accuracy and adequacy solutions announced today the Centers for Medicare & Medicaid Services (CMS) has extended their contract with Quest Analytics for an additional five-year term to measure the adequacy of all Medicare Advantage Part C & D and Medicare-Medicaid Health Plans’ (MMP) provider, […]
The Rebirth of Network Adequacy: Modernizing Health Plan Practice
Reprinted from The URAC Report. Nearly two months ago now CMS finalized changes to Medicare Advantage (MA) and Part D for 2021 and while I previously covered the new telehealth network adequacy provisions, I’ve been meaning to do a deeper dive into how network adequacy as a whole has changed in recent years. To do this, I reached out to Cari […]
Preparing for the Era of Provider Network Transparency
Copyright 2020 Compliance Today, a publication of the Health Care Compliance Association (HCCA). Transparency is one of the top buzzwords in healthcare today. In the last few years, we have seen the rollout of significant healthcare transparency initiatives focused on portable health records, hospital costs, drug costs, quality data, and many other things (e.g., Executive […]
Rule Raises Questions About Telehealth, Directory Accuracy
Reprinted with AIS Health permission from the July 2, 2020, issue of RADAR on Medicare Advantage. As Medicare Advantage and other insurers report increasing use of telehealth during the COVID-19 pandemic and consider the larger role that virtual visits could play on a more permanent basis, CMS recently finalized a set of policies for 2021 […]
ESRD Enrollment Creates Cost, Network Unknowns for MAOs
Reprinted with AIS Health permission from the July 2, 2020, issue of RADAR on Medicare Advantage. As Medicare Advantage plans prepare to enroll patients with end-stage renal disease (ESRD) this fall, a recent change to network adequacy measurement will give them some flexibility in how they include dialysis care in their networks. Meanwhile, a new lawsuit […]
Pressure Mounts on MA Plans to Address Racial Disparities
Reprinted with AIS Health permission from the June 18, 2020, issue of RADAR on Medicare Advantage As protests erupt across the U.S. calling for racial justice and police reforms, the COVID-19 pandemic continues to bring to light many of the racial disparities in health care, putting pressure on policymakers and the industry to take a hard […]
The Health 202: Trump Administration Lets Medicare Plans Off the Hook
Reprinted from the December 4, 2018, article in The Washington Post THE PROGNOSIS The Trump administration is holding off on punishing Medicare Advantage plans for error-ridden doctor directories — further evidence the conservative-led Centers for Medicare and Medicaid Services is showing special favor to the alternative program over traditional Medicare offerings. In an audit quietly released late […]
