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AMA: Bye-Bye Medicare Billing Codes?

Posted on November 22, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Robert F Kennedy Jr, who was selected by Donald Trump to run the U.S. health and human services department, is working on plans to rid the American Medical Association from its role in drawing up Medicare’s billing codes, which sets doctors’ fees for more than 10,000 procedures, Oliver Barnes of The Financial Times reports.

The plan would result in an upheaval of a system that has been in place for decades. Publicly traded companies in the healthcare space include CVS Health (CVS), Centene (CNC), Cigna (CI), Elevance Health (ELV), Humana (HUM), Molina Healthcare (MOH) and UnitedHealth (UNH).

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Filed under: "Doctors Only", Accounting, Experts Invited, Glossary Terms, Health Economics, Health Insurance, Healthcare Finance, Insurance Matters, Risk Management, Taxation | Tagged: AMA, billing codes, Centene, CI, Cigna, CMS, CNC, CPT codes, CVs, Elevance Health, ELV, Financial Times, HUM, Humana, medicare, medicare billing codes, MOH, molina, Oliver Barnes, robert f. kennedy jr., RVUs, UNH, United Health Care | Leave a comment »

DAILY UPDATE: Centene Down but Technology Stocks Blast-Off

Posted on August 9, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

MEDICAL EXECUTIVE-POST – TODAY’S NEWSLETTER BRIEFING

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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants

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SPONSORED BY: Marcinko & Associates, Inc.

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Almost 40,000 seniors will be forced to change Medicare Advantage plans after yet another insurer decides to exit markets over cost concerns. Centene Corp announced it would be ending its Medicare Advantage plans in at least six states this year as the company faces cost pressures.

CITE: https://www.r2library.com/Resource

What’s up

Occidental Petroleum jumped 4.37% on a mixed earnings report that saw Warren Buffett’s favorite oil company beat on earnings but miss on revenue.
Zillow rose faster than the price of a three-bedroom in Austin, rising 18.19% thanks to strong earnings and a clearer succession plan for its CEO.
Penn Entertainment popped 8.45% on a strong earnings beat despite paying a hefty fee for ESPN Bet.
Duolingo s’eleva 10.90% thanks to a solid earnings announcement and the promise of even better returns in the coming fiscal year.
Klaviyo rocketed 33.28% after an impressive beat-and-raise earnings announcement.
Hanesbrands surged 18.17% in spite of sales sagging faster than the waistband of your favorite old pair of undies. Shareholders liked that the company has become more lean and efficient after selling its Champions brand.

What’s down

Bumble stumbled 29.16% after management forecast third-quarter revenue will come in well below Wall Street estimates.
Monster Beverages sank 10.93% thanks to a miss on both the top and bottom lines that management blames on shifting consumer sentiment.
Dutch Bros plummeted 19.93% due to expectations of lower same-store sales growth in the coming months.
SolarEdge Technologies fell 3.05% despite beating revenue forecasts, but its bottom line was weaker than expected.
JFrog tanked 27.52% after beating profit estimates, missing revenue estimates, and guiding for a much worse third quarter and fiscal year than expected.

CITE: https://tinyurl.com/2h47urt5

Here’s where the major stock market benchmarks ended:

The SPX rose 119.81 points (2.3%) to 5,319.31; the Dow Jones Industrial Average^® ($DJI) climbed 683.04 points (1.76%) to 39,446,49; the NASDAQ Composite^® ($COMP) rose 464.21 points (2.9%) to 16,660.02.
The 10-year Treasury note yield (TNX) rose to just under 4%.
The Cboe Volatility Index^® (VIX) fell to 23.79.

CITE: https://tinyurl.com/tj8smmes

Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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Filed under: Alerts Sign-Up, Drugs and Pharma, Ethics, Experts Invited, Financial Planning, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Information Technology, Investing, Managed Care, Marcinko Associates, Recommended Books, Sponsors, Touring with Marcinko | Tagged: Centene, DJIA, DOW, Marcinko, Medicare Advantage, Medicare C, NASA, NASDAQ, S&P 500, SPX, stock markets, textbooks, TNX, VIX, WSJ | Leave a comment »

MEDICARE ADVANTAGE PLANS: Part C Plans Down AS Cigna Pays Up?

Posted on October 3, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

Hospitals are Dropping Medicare Advantage [Part C] Plans – Left and Right

By Dr. David Edward Marcinko MBA

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Hospitals Say Bye-Bye?

Medicare Advantage provides health coverage to more than half of the nation’s seniors, but a growing number of hospitals and health systems nationwide are pushing back and dropping the private plans altogether. Among the most commonly cited reasons are excessive prior authorization denial rates and slow payments from insurers. Some systems have noted that most MA carriers have faced allegations of billing fraud from the federal government and are being probed by lawmakers over their high denial rates.

“It’s become a game of delay, deny and not pay,” Chris Van Gorder, president and CEO of San Diego-based Scripps Health, told Becker’s. “Providers are going to have to get out of full-risk capitation because it just doesn’t work — we’re the bottom of the food chain, and the food chain is not being fed.” Van Gorder said the health system is facing a loss of $75 million this year on the MA contracts, which will end December 31st for patients covered by UnitedHealthcare, Anthem Blue Cross, Blue Shield of California, Centene’s Health Net and a few more smaller carriers.

Source: Becker’s Hospital Review [9/27/23]

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Cigna to Pay $172M Over Alleged Medicare Advantage Fraud

The Cigna Group will pay $172.3 million to resolve allegations that it violated the False Claims Act by submitting incorrect Medicare Advantage patient data to CMS to receive higher payments from the agency. The U.S. Attorney’s Office for the Eastern District of Pennsylvania alleged Sept. 30 that Cigna also falsely certified that the submitted data was accurate, failed to withdraw the “untruthful” data, and did not repay CMS.

Cigna will use $135.3 million from the settlement to resolve the allegations from the Justice Department. The remaining $37 million will resolve allegations related to unsupported diagnoses for Medicare Advantage enrollees that received in-home services from Cigna. As part of the settlement, Cigna has entered into a five-year accountability and auditing agreement with HHS’ Office of Inspector General, which will require company executives and board members to certify Cigna’s compliance moving forward. The payer must also conduct annual risk assessments and submit to independent risk adjustment audits.

Source: Jakob Emerson, Becker’s Payer Issues [10/2/23]

Thank You

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Filed under: Ethics, Experts Invited, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Managed Care, Marcinko Associates, Touring with Marcinko | Tagged: Anthem, Becker's, Blue Shield California, Centene, Cigna, david marcinko, Dr. Marcinko, Marcinko Associates, medicare, Medicare Advantage, Medicare C, Part C, Part C Medicare, UnitedHealthcare | Leave a comment »

CENTENE CORPORATION: Medicaid Over-Billing?

Posted on December 31, 2022 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Centene Corporation showers politicians with millions as it courts contracts and settles over-billing allegations by Samantha Young, Andy Miller, and Rebecca Grapevine (Kaiser Health News)

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Somehow KHN made Medicaid over-billing sound sexy.

This deep dive into Centene, “the nation’s largest private managed-care provider for Medicaid,” shows how the company has maintained good relationships with politicians as it looked to keep its market share and settle over-billing allegations.

CITE: https://www.r2library.com/Resource/Title/082610254

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PODCAST: https://medicalexecutivepost.com/2021/11/12/podcast-centene-giant-medicaid-hmo/

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ORDER: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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Filed under: "Doctors Only", Accounting, Career Development, Ethics, Experts Invited, Health Economics, Health Insurance, Managed Care, Op-Editorials | Tagged: Andy Miller, Centene, Centene Corporation, CENTENE: Medicaid Over-Billing?, KHN, Medicaid, Medicaid Over-Billing?, Rebecca Grapevine, Samantha Young | Leave a comment »

“For-Profit” Medicare Advantage Plan Growth

Posted on March 16, 2022 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Chartis: For-Profit Medicare Advantage Plan Growth 2022

• UnitedHealth Group: 765K new lives
• Centene Corporation: 338K new lives
• CVS Health/Aetna: 323K new lives
• Humana: 315K new lives
• Bright Health: 109K new lives

Source: The Chartis Group, “Medicare Advantage Enrollment Continues to Surge in an Increasingly Complex and Competitive Landscape,” February 2022

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Filed under: Accounting, Experts Invited, Health Economics, Health Insurance, Healthcare Finance | Tagged: Bright Health, Centene, CVS Health/Aetna, For-Profit Medicare Advantage Plan Growth 2022, Medicare Advantage, Part C, United Health Group | Leave a comment »

PODCAST: Ascension Non-Profit Hospital System

Posted on November 16, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

THE LARGEST IN THE USA

BY DR. ERIC BRICKER MD

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Filed under: "Doctors Only", Career Development, Experts Invited, Health Economics, Health Insurance, Healthcare Finance, Managed Care, Practice Management, Research & Development, Videos | Tagged: Ascension, Ascension Hospitals, Ascension Non Profit Hospitals, Centene, Dr. Eric Bricker MD, Non Proft Hospitals | Leave a comment »

PODCAST: Centene the Giant Medicaid HMO

Posted on November 12, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

MEDICAID AND A.C.A. the GIANT

By Eric Bricker MD

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HOSPITALS: https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

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HEALTHCARE: https://www.amazon.com/Hospitals-Healthcare-Organizations-Management-Operational/dp/1439879907/ref=sr_1_4?s=books&ie=UTF8&qid=1334193619&sr=1-4

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Filed under: "Advisors Only", "Doctors Only", Accounting, Career Development, Experts Invited, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Op-Editorials, Videos | Tagged: ACA, Centene, centene medicaid hmo, Eric Bricker MD, HMO, MCO, Medicaid, Medicaid HMO | Leave a comment »

Seeking Chief Medical Director [CMD]

Posted on May 29, 2011 by Dr. David Edward Marcinko MBA MEd CMP™

Magnolia Health Plan

By Missy Wohldmann

Dear Dr. Marcinko and ME-P Readers,

Centene Corporation is seeking a Chief Medical Director (CMD) for Magnolia Health Plan (Magnolia), a wholly-owned subsidiary and HMO for the state of Mississippi. The regional headquarters for Magnolia is located in Jackson, Mississippi.

About Centene

A Fortune 500 company, Centene is a national leader in low-cost solutions for high quality healthcare services for uninsured and underinsured patients. Centene’s subsidiary health plans bring better health outcomes to their 1.5 million members. Centene’s core philosophy is that quality healthcare is best delivered locally. This local approach enables them to provide accessible, high quality and culturally sensitive healthcare services to their members in their own communities.

Visionary Needed

The Chief Medical Director will establish the strategic vision and attendant policies and procedures for Magnolia Health Plan. The CMD will provide leadership and direction to the medical management, quality improvement and credentialing functions for Magnolia Health Plan based on, and in support of, the company’s strategic plan. The CMD will review analyses of activities, costs, operations and forecast data to determine progress toward stated goals and objectives. Also within the purview of CMD will be oversight for compliance with National Committee on Quality Assurance (NCQA) and/or Joint Commission on Accreditation of Healthcare Organization (JACHO) standards as determined for accreditation of the health plan.

Candidates

Successful candidates will be physician leaders with thorough knowledge of quality improvement practices and familiarity with medical information systems, medical claims payment processing and coding. Knowledge of managed care, Medicaid, and case management programs are also essential. Board certification in a recognized medical specialty and an active medical license are required.

We welcome your interest, or nominations, for this highly visible role.

Assessment
Cejka Executive Search
4 CityPlace Dr., Ste. 300
St. Louis, MO 63141
314.236.4478 Office
mwohldmann@cejkasearch.com
http://www.cejkaexecutivesearch.com

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Filed under: "Doctors Only", Career Development | Tagged: Cejka Executive Search, Centene, Magnolia Health Plan, Missy Wohldmann, Seeking Chief Medical Director | Leave a comment »

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