In this episode, Olga Barone-Allan, BESLER’s Director of Revenue Integrity, provides us with a glimpse into our next webinar, Medicare Advantage: Emerging Trends in 2024, presented live Wednesday, May 1, at 1 PM ET.
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Learn how to listen to The Hospital Finance Podcast® on your mobile device.Highlights of this episode include:
- What to expect from the upcoming webinar
- Medicare Advantage enrollment trajectory
- Updates from CMS in 2024 for Medicare Advantage
- Major improvements
Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome back Olga Barone-Allan, BESLER’s Director of Revenue Integrity. In this episode, Olga will provide us with a glimpse into our next webinar, Medicare Advantage: Emerging Trends in 2024, that we’re presenting live on Wednesday, May 1, at 1 PM Eastern Time. Welcome back, and thank you for joining us, Olga.
Olga Barone-Allan: Thank you, Kelly. It’s a pleasure to be here on your podcast.
Kelly: Well, awesome. Let’s go ahead and jump in. So, most people in our audience will be familiar with Medicare Advantage plans, but could you give us a brief overview on what to expect from your upcoming webinar?
Olga: Absolutely. Our upcoming webinar on May 1st is called Medicare Advantage: Emerging Trends in 2024. And we’ll be covering an overall background on Medicare Advantage, differences between Medicare and Medicare Advantage. We’ll touch on the Transfer DRG rule and how it impacts Medicare Advantage, the benefits of an independent TDRG Medicare Advantage billing review, enrollment stats in Medicare Advantage, available Medicare Advantage Plans, 2024 Medicare Advantage, and Part D Final Rule known as CMS-4201-F. And I will share some action items for providers and provide just answers to questions that were raised at the last webinar on the same topic from last year.
Kelly: Sounds like there’s going to be a lot of good content in this one. So, we know that Medicare Advantage plans have been increasing in popularity. What does the enrollment trajectory look like?
Olga: So, if you were around when Medicare Advantage came out in healthcare, you would remember everyone in the industry was hesitant to embark with this new approach and leave traditional Medicare. In looking at the trends in 2004, only 5.5 million Medicare patients enrolled in Medicare Advantage. Now you see in 2023, 31 million Medicare patients enrolled in Medicare Advantage. Based on the information provided by CMS today, the growth rate of patients opting for Medicare Advantage plans from 2022 to ’23 was around 8%, which is the same percentage growth between 2021 to 2022. And it is predicted to grow at that rate each year going forward, if not more. The only thing to keep in mind is that now the average Medicare beneficiary in 2023 has access to 43 Medicare Advantage Plans. That’s the largest number of options available in more than a decade.
Kelly: Wow, that’s substantial. And that is a lot of growth. So, what are some of the updates from CMS in 2024 for Medicare Advantage?
Olga: Sure. So, according to the 2024 Medicare Advantage and Part D Final Rule issued on April 5th, 2023, CMS issued a final rule that revises the Medicare Advantage or Part C, Medicare Prescription Drug Benefit Part D, Medicare cost plan, and Programs of All-Inclusive Care for Elderly, regulations to implement changes related to Star Ratings, marketing and communication, health equity, provider directories, coverage criteria, prior authorization, network adequacy, and other programmatic areas.
Kelly: Thank you for sharing those updates with us. What are two major improvements addressed in the CMS-4201-F final rule?
Olga: So, CMS clarified in its final rule that MA plans must also follow the two-midnights rule. It’s a case-by-case exception, and the inpatient-only list beginning in 2024. On February 6th, CMS issued guidance to ensure. Stating MA plans are required to follow these inpatient admission criteria. However, they do not have to follow the two-midnight presumption, which relates to the medical review instructions within traditional Medicare. And then the second major change is the use of prior authorization by Medicare Advantage Plans and the effect on beneficiary access to care.
Kelly: Wow. Thank you for sharing those too. So, what else will you cover during this webinar?
Olga: The benefits of an independent TDRG Medicare Advantage Billing Review is on the top of the list. And then we have some tips for providers. And again, answers to questions that were raised at last year’s webinar on this topic. I encourage our listeners to attend our webinar on May 1st to hear more details on this topic.
Kelly: As am I. Sounds like there’s going to be a lot of great content covered. Well, thank you so much for joining us today, Olga, and for sharing this sneak peek into our upcoming webinar, Medicare Advantage: Emerging Trends in 2024.
Olga: Thank you, Kelly.
Kelly: And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…
[music] This concludes today’s episode of the Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.com/podcasts. The Hospital Finance Podcast is a production of BESLER | SMART ABOUT REVENUE, TENACIOUS ABOUT RESULTS.
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