Together, these reports capture a period of intensifying scrutiny of how Medicare Advantage manages post-acute care.
Frustration was boiling into open conflict within NaviHealth, a company that uses computer predictions to help control the cost of caring for millions of older and disabled Americans on privatized Medicare plans. The source of the outrage was not a customer or a salesperson, but an algorithm — specifically one that was being used to predict the amount of care needed by seriously ill patients. In 2021, employees raised alarms that efforts to bypass the algorithm — and pay for longer rehab stays — were getting slapped down at higher levels of the organization.
— STAT, July 11, 2023
CMS Releases New Data on Medicare Advantage Beneficiaries’ Use of Skilled Nursing
In 2019, there were about 46.6 skilled nursing facility stays per 1,000 Medicare Advantage beneficiaries on a national basis. The data also showed there were about 945 SNF days per 1,000 Medicare Advantage beneficiaries on a national basis in 2019. The federal agency shares public use files from time to time to support timely benefit and rate analysis for researchers and other stakeholders, and the latest information pertains to state-by-state variations in use of Medicare Advantage plans within SNFs.
— Skilled Nursing News, June 12, 2023
Medicare Advantage Is Neither Medicare Nor an Advantage
Medicare Advantage is a money-making scam. I should know. I helped to sell it. But here is the truth: Medicare Advantage is neither Medicare nor an advantage. And I should know. I am a former health-care executive who helped develop PR and marketing schemes to sell these private insurance plans.
— The Rowan Report, February 1, 2023
✔ Comply with every payer's rules
✔ Equip your team with the Playbook
✔ Monitor rates and payer trends
