Vaughn Hurst

Interesting letter sent to Chiquita Brooks-LaSure, the Administrator of CMS by Senator Ron Wyden and Congressmen Frank Pallone JR and Richard Neal about Medicare Advantage. From the letter (out of order) "The foundation of this work must start with required reporting of what MA plans are spending on marketing and commissions, which companies (and those companies’ subcontractors) are receiving those payments, and how those payments are structured." "Second, MA insurers continue to bait and switch beneficiaries and taxpayers in their marketing" "MA plan advertisements too often gloss over information about the core Medicare benefits in favor of supplemental benefits like gym memberships and flex cards" "a Senate Finance secret shopper investigation found that more than 80 percent of the listed, in-network, mental health providers in a sample of MA plans were “ghosts,” as they were either unreachable, not accepting new patients, or not in-network" "with more than $6 billion in MA plan spending on commissions and marketing, brokers are under pressure to churn through appointments as quickly as possible. The demand for volume means brokers are under pressure to focus on only a few plans and may not examine the full range of options" All three of the signees are well over 65 years old. Although they don't need to worry about Medicare personally, I do wonder if their own age makes them more sensitive to these issues for seniors. Then again, 54% of senators are older than 65 as are 34% of members of Congress. Their may be a new CMS administrator regardless of who wins the election, these issues will continue to be a big part of the conversation. https://lnkd.in/e-58xYrM

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We recently posted our view that medical networks are more of an interference and barrier to needed medical services than a means to reduce costs to employer sponsored group health plans. Evidently, this extends beyond group plans and reaches into the ACA market plans as much, if not more. We recently received an article from an online information source titled, “Size of physician networks varies widely among ACA Marketplace plans, study finds” written by Alan Goforth. The gist of the article reported that these network-based plans only have policyholders access to a modest percentage of doctors in their respective communities. The article reported that “on average, more than one quarter of actively practicing physicians were not included in any marketplace plan network.” The question I raise is WHY NOT? People buy medical insurance to have a pathway to healthcare when needed. How have we allowed ourselves to evolve to a system whereby when we buy insurance, it operates like an exclusive boys and girls club of practicing doctors? How did we evolve to this point whereby we have ceded control of our medical funding resources to third parties who decide not only what we can have with our money, but who we are allowed to get what we need from? It seems to me that the more gimmicks that third parties conceive and market to the public as the latest and greatest cost control devise; the more expensive health care becomes and the narrower the choices as to where we can go to get it are becoming. We continue to advocate that groups have to take back control of the funding that represents claims reserves and be in stronger positions to determine what you can have and where you can go. Whomever controls the money, controls the system. In our view, employers must flip the equation as to who controls the funding for claims. When we give up control of our funds, the system controls us! When we take control of these funds, we control the system! Our groups control their claims reserves in order to minimize the above-mentioned problems. Let us show you how! To learn more, contact us. The Ecchic Group 314-997-8865 www.ecchic.com 11704 Lackland Industrial Drive St. Louis, MO 63146 Article: https://lnkd.in/g-qnSrpA

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Here's the bottom line! Your traditional Medicare and a Medicare Supplement clients might be at risk if the hospital approaches them with a MOON (Medicare Outpatient Observation Notice)? This notice can significantly impact their coverage and finances. Here's what you need to know: • The MOON notice indicates that the patient is an outpatient, not an inpatient. • If they require a skilled nursing facility after their hospital stay, Medicare won’t cover the costs unless specific conditions are met. • Your clients could face a $10,000 upfront cost for the first month of rehabilitation! But there’s a solution: short-term nursing home care. It fills the gap, covering home care, assisted living, and nursing facilities for a shorter duration, with more lenient underwriting and at a more affordable cost. Make sure you're informed and ready to help your clients navigate these challenges. If you need more info, message me, and I'll get it to you. #Medicare #Motivation #StayPositive #ClientCare

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Medicare Agents and Brokers I want to share more with you on how NABIP is standing firm in protecting your interests and the communities we serve.#nabip

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The transition from Fee-For-Service to value-based care in healthcare is essential. This article emphasizes the importance of focusing on quality outcomes over process measures to establish meaningful value-based care more effectively and on a larger scale. #Healthcare #ValueBasedCare #QualityOutcomes

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I always appreciate Sam’s posts as they are thoughtful and concise. What really upsets me about the letter from these Senators to CMS is how callously the word “brokers” is used in the paragraph below: —- “with more than $6 billion in MA plan spending on commissions and marketing, brokers are under pressure to churn through appointments as quickly as possible. The demand for volume means brokers are under pressure to focus on only a few plans and may not examine the full range of options” —- Let me be clear, the large majority of brokers are NOT under pressure to churn. We do NOT only examine a few plans. The actions being described are that of a call center. And therein lies the problem. The fact that our government officials clearly do not understand the difference between a call center and a broker is a tremendous problem. If we cannot educate our government officials regarding the difference, we are all going to be out of a career. Plain and simple. Pinnacle Financial Services, Inc. Tyler Insurance Group Angela Palo Kevin Shields Nick Palo NABIP Laura Tyler Andrew Horn, MHA Caroline Horn Eric Price, MBA Christopher Raon

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Why choose Direct Primary Care (DPC)? Employers who adopt DPC models often see a significant reduction in administrative costs. By eliminating insurance claims for primary care, we simplify the process and improve access to high-value primary care providers.

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As Bob Dylan famously sang, "The Times They Are A-Changin'." Indeed, we're facing some possible changes to Medicare Advantage that could impact us all. It’s important to stay informed and prepared as we navigate these shifts. By understanding what's on the horizon, we can continue to provide the best service and advice to our clients. But amidst all these changes, there’s one thing that remains steadfast and reliable: Hospital Indemnity! It’s the perfect complement to any Medicare plan, offering additional peace of mind and financial protection. Hospital Indemnity is a true constant in an ever-evolving landscape, and it continues to be a "win-win" for both agents and clients. Now is the time to leverage the stability of Hospital Indemnity to make a real difference. By educating our clients on its benefits, we not only enhance their coverage but also reinforce our role as trusted advisors. This product bridges the gap between Medicare Advantage and Supplement plans, ensuring comprehensive protection for our clients. Let’s embrace the opportunity to make a positive impact. Get out there, share your knowledge, and start selling! Every conversation you have is a chance to make someone’s life a little easier and a lot more secure. Together, we can navigate these changes and come out stronger on the other side. Remember, success is not just about numbers; it’s about the lives we touch and the peace of mind we provide. So, let's all be winners! Stay positive, stay motivated, and let’s make a difference in the lives of our clients. #Medicare #Motivation #StayPositive #ClientCare

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United HealthGroup reported their earnings yesterday and their earnings call was chock full of interesting tidbits Tim Noel , the CEO of Medicare for UHG was on the call again, what he said probably left a lot of distributors wondering what he means “we continue to believe that there's opportunities to improve the distribution environment in Medicare Advantage and have been in a dialog with CMS for several years on how to do that. Some of the elements of the final notice that were published recently are directly in line with some of our recommendations and some of them are relatively consistent, but not totally as we had conceived them”  “it's a little bit early to comment on how this might rebalance some of the channel mix, as still some questions on how some of the key elements of that will be rolled out.” Pretty aggressive wording about how much influence they have with CMS The Change Healthcare hack was the first thing mentioned after a couple of quarters where Medicare Advantage led things off on the earnings calls Andrew Witty, the CEO was strident in his defense of Medicare Advantage as a better deal for seniors financially as well as with care outcomes. Interesting to see how strong he was here considering UHG’s market leadership in Medsupp as well Their commercial business had its largest quarterly gain in years, likely driven by some recent marker exits by Humana and Aetna, although UHG said it was mostly from their innovative products. Individual exchange business was also mentioned as a growth driver MLR on Medicare Advantage went down from the 85% in Q4 to 84.3% and that is inflated by 40 basis points due to suspension or care management plus an additional $800 Million due to claims reserves related to the cyberattack AJ Rice from UBS asked about the $800 Million and they basically said the actual claims costs will be more than 0 but less than $800 million, so MLR is down at least a full point and maybe more in reality Jared Strock also posted some great analysis diving into the numbers, check it out!

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**CMS Finalizes Medicare Payment Updates for FY 2025** The Centers for Medicare & Medicaid Services (CMS) has announced a final rule that will increase Medicare inpatient prospective payment system (IPPS) rates by a net 2.9% for fiscal year 2025. This adjustment aims to support hospitals that actively use electronic health records and submit quality measure data. The update reflects a 3.4% hospital market basket increase, offset by a 0.5% productivity cut, resulting in an overall payment increase of $2.9 billion. Key Points: - The payment update includes a $200 million decrease in disproportionate share hospital payments and a $300 million increase in new medical technology payments. - The American Hospital Association (AHA) has expressed concerns that these updates may worsen the financial challenges faced by hospitals, particularly in rural and underserved communities. - CMS finalized the Transforming Episode Accountability Model (TEAM), which mandates participation from inpatient PPS hospitals in specific areas starting January 1, 2026, covering five surgical episode categories. - Additional provisions include the adoption of new statistical areas for wage index determination, a separate payment for small independent hospitals, and the distribution of new graduate medical education slots. CMS has also implemented changes in quality reporting, including adding new patient safety measures and requiring hospitals to report data on acute respiratory illnesses weekly. These provisions will generally take effect on October 1, 2024. #Medicare #HealthcarePolicy #CMS #HospitalPayments #HealthTech #RuralHealth #PatientCare #QualityReporting #HealthcareInnovation

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A very interesting and needed proposal. Getting the LTC and Medical parts of the equation together for the benefit of Seniors. This has been a gaping whole in coverage that the private market has not been able to address. It kind of reminds me the pharmacy gap that existed before Part D came along. What is your take on this proposal?

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I just saved $270 by using AblePay Health to pay for an unexpected ER visit for our son a few months ago. Our son is fine now, that is most important. The service and courtesy of the medical professionals was ok. But the billing process... yikes. I received countless bills and EOBs, some of which were repetitive, easily confusing even a well versed health insurance professional. After finally determining my actual balance, I started advocating. I never pay the first bill. I requested itemized bills with codes. I questioned the bills. I called provider and carriers. I attempted to negotiate rates. It was a headache and time consuming, all of which I believe is a tactic to get you to pay-up or give up. The $270 was a small win for us, but still a win. Never pay the first bill and learn more about that here 😉 https://lnkd.in/eM4-uvbK

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As healthcare providers continue to navigate the complexities of modern claims management, the latest data from a 2024 report paints a concerning picture: denial rates are rising, complicating revenue collection and creating a cascade of operational challenges. Click the link to read more: https://lnkd.in/gHtCYsBE #denialmanagement #practicemanagement #revenuecyclemanagement #medicalbillingcompany

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The healthcare industry owes a great deal to all of the dedicated medical professionals in the industry. But the same holds true for the Healthcare Risk Managers! These folks commit their time and energy to doing the unseen, and often unpopular, work of trying to keep their organizations, institutions and patients therein safe. HUB International thanks all of these professionals for the professionalism, dedication and tireless efforts. Please join HUB International's Healthcare Specialty Practice in celebrating American Society for Health Care Risk Management (ASHRM)'s Healthcare Risk Managers Week. #healthcare #healthcareriskmanagement #HRMWeek #riskmanagement

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Medicare Supplement OR Medigap (same thing) These plans are standardize. The benefits do not change from year to year and they are the same with each carrier, in every state. If carrier Red offers Plan G, in AR or OK, the benefits are the SAME. The premium will vary by state and by carrier. Medicare sets the Part B deductible each year, so regardless of carrier, you will pay the Part B deductible ($240 for 2024), then Medicare pays 80% and your Supplement pays your 20%. There are guarantee windows to get a Medicare Supplement. You can't just change between a Medicare Advantage and Medicare Supplement during the Annual Election Period (Oct 15-Dec 7) every year. There are exceptions, so be sure to ask what those are. #RedlineHealth #MedicareEducationWeek #MedicareAndMotorcycles #BrokersMakeaDifference

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Recently there have been numerous articles discussing some of the issues about Medicare Advantage plans. Many providers are deciding to no longer accept some of these types of plans. Unfortunately, that can leave many people without the ability to continue seeing providers that they may have long-standing relationships. However, one issue that is not mentioned in these articles is that in some states, once you have made the decision to enroll in a Medicare Advantage plan, you may not be able to enroll in any other type of coverage. For instance, in most states, if you do not enroll in a Medicare Supplement ("Medigap") plan when you first become eligible for Medicare, you may never be able to obtain one in the future. Medicare Supplement plans can ask 'medical questions' to determine if you have pre-existing conditions, and deny selling you a plan or raising the monthly premiums. This can make it almost impossible to switch from a Medicare Advantage plan to a Medicare Supplement plan. People need to be made aware of these issues when they are first deciding what type of Medicare coverage would best meet their current, and future needs.

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Understanding the unique needs of different generations is crucial in providing them with the right coverage. Seniors often seek the most comprehensive insurance they can afford, but many misunderstand Medicare Advantage's limitations. Join Brandon Clay and myself for an exclusive Drip the HIP Wired event Live on LinkedIn this Tuesday, June 4th, as we dive deeper into bridging these gaps and ensuring better security for our seniors. #InsuranceInsight #LinkedInLive #MedicareAdvantage

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🔵 Friday 9/20/2024, the Centers for Medicare & Medicaid Services (CMS) Published Updates 🔵 September 6: Revised Guidance on Rural Emergency Hospitals (REHs) Enrollment CMS released updated guidance on REHs enrollment and conversion to assist eligible providers interested in participating in Medicare and Medicaid as REHs. REHs were established by the Consolidated Appropriations Act of 2021 to address rural hospital closures. The revised memo adds further clarity and responds to stakeholder feedback. September 9: CMS Seeks Comments on Mental Health Parity Compliance Templates CMS requests public comments on templates and guides to help states and managed care plans ensure compliance with mental health and substance use disorder parity under Medicaid and CHIP. The templates will standardize information submissions and streamline CMS' review process for compliance with parity rules. September 9: Save the Date for 2024 CMS Conference CMS announced the 2024 CMS Conference on Optimizing Healthcare Delivery to Improve Patient Lives will be held virtually on December 12, 2024. The event will focus on reducing administrative burden and improving access to quality care, with more details on sessions and speakers to come. September 12: Montana’s State Innovation Waiver Extension Approved CMS approved Montana’s waiver extension for its Health Insurance Individual Market Stabilization Reinsurance Program through 2029. The program aims to lower premiums in the individual market and increase coverage for consumers in Montana. September 17: CMS Releases First Evaluation Report on Kidney Care Choices Model The first evaluation report for the Kidney Care Choices (KCC) Model shows increases in home dialysis and training, as well as improvements in dialysis initiation. No significant changes were noted in transplant rates or Medicare spending in the first year. September 17: CMS Pilots Qualified Health Plan Directory CMS is partnering with Oklahoma to pilot a centralized directory for Qualified Health Plans and providers, aiming to improve data accuracy and user experiences for patients and providers. Additional Updates: September 6: CMS notified individuals potentially impacted by a data breach. September 9: Final rules were issued to strengthen access to mental health and substance use disorder benefits. September 12: CMS approved New Hampshire’s request to offer essential behavioral health services via mobile crisis teams. September 13: CMS provided resources to assist Louisiana during the public health emergency.

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