Scrutiny Of Risk Adjustment Practices Looms Over Medicare Advantage As Open Enrollment Starts

Medicare open enrollment kicked off Friday with more Medicare Advantage plans to choose from but with renewed criticism that insurers are gaming risk adjustment practices to inflate profits. While more and more insurers are expanding their presence in the MA marketplace, private Medicare plans are facing heightened scrutiny over risk adjustment and comprehensive diagnostic coding. ...

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No Plans To Require Proof Of Vaccination In Nevada, Sisolak Says

One day after Los Angeles approved a requirement for proof of full vaccination to enter restaurants and other indoor venues in that city, Gov. Steve Sisolak said he did not envision a similar requirement in Nevada. “I am not anticipating any more mandates, as you’re talking about in L.A.,” Sisolak said on Thursday. “I want ...

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Making Enhanced ACA Subsidies Permanent Could Extend Coverage To Nearly 1M

Nearly 1 million uninsured children and parents could get insurance coverage if temporary, enhanced income-based subsidies on the Affordable Care Act’s exchanges would be made permanent, new data show.

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Large Majorities Want Medicare To Negotiate Drug Prices, Poll Finds

Large majorities of American voters across all political stripes favor letting Medicare negotiate drug prices, and most don't buy into the argument that high drug prices are needed for drug companies to invest in new research, according to a new poll from the Kaiser Family Foundation.

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Kaiser Family Foundation: 7 In 10 Medicare Beneficiaries Don’t Shop For New Plans

New data show that 7 in 10 Medicare beneficiaries didn’t compare plans during the 2018 open enrollment period, even though plans can change in their benefits and costs.

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Surprise-Billing Rule ‘Puts a Thumb on the Scale’ to Keep Arbitrated Costs in Check

Patients are months away from not having to worry about most surprise medical bills — those extra costs that can amount to hundreds or thousands of dollars when people are unknowingly treated by an out-of-network doctor or hospital.

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Biden Touts Vaccine Mandates For Large Businesses: ‘These Requirements Work’

President Joe Biden renewed his call for private employers to require their workers to get vaccinated against COVID-19, saying “we are going to beat this pandemic” if more Americans get their shots. “Without them, we face endless months of chaos in our hospitals, damage to our economy and anxiety in our schools and empty restaurants and much ...

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Health Industry Wields Power in California’s High-Stakes Battle to Lower Health Care Costs

Gavin Newsom put California’s health care industry on notice when he was a candidate for governor, vowing in 2018 to go after the insurance companies, doctors and hospitals that leave many Californians struggling with enormous medical bills and rising insurance premiums.

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San Francisco To Lift Some Mask Rules Oct. 15; Other Bay Area Mask Mandates Likely To Remain For Months

San Francisco will loosen its mask mandate for certain indoor spaces on Oct. 15, but in the city and much of the rest of the Bay Area, people will still be required to wear face coverings in most public places for the next couple of months and possibly into 2022, according to new rules announced Thursday.

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90% of Medicare Advantage Enrollees Enrolled in Highest-Quality Plans

Nine out of 10 Medicare Advantage members are enrolled in plans that earned the government's highest quality marks for 2022, according to new federal data.

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