AMA: Bye-Bye Medicare Billing Codes?

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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UNITEDHEALTHGROUP: Recent Pros and Cons of UNH

By Staff Reporters

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A class action lawsuit has been filed in Minnesota against UnitedHealth Group (NYSE:UNH) over allegations that the health insurer and its subsidiary, NaviHealth, used a faulty algorithm to deny rehabilitation care for Medicare Advantage beneficiaries. California-based Clarkson Law Firm filed the lawsuit in the U.S. District Court of Minnesota on Tuesday following an investigative report published by the health-focused news site Stat.

It alleges that UnitedHealth and its subsidiary, NaviHealth, used the computer algorithm named nH Predict to “systematically deny claims” of patients recovering from debilitating illnesses in nursing homes. According to the lawsuit, despite its 90% error rate, the company used the algorithm to deny claims, knowing that only 0.2% would appeal its decision. According to Stat, Humana (HUM), the nation’s second-largest player in the Medicare Advantage market behind UnitedHealth (UNH), also uses nH Predict. UnitedHealth (UNH) denied it used the NaviHealth predict tool to arrive at coverage decisions.

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Ironically, UnitedHealth’s (NYSE:UNH) Optum Rx unit announced plans to move eight insulin products to “preferred” status on formularies to further expand the number of patients benefiting from $35 or less monthly out-of-pocket costs for the lifesaving therapy.

Optum Rx, UNH’s pharmacy benefit manager (PBM), said that effective January 1, 2024, all short- and rapid-acting insulins will move to Tier 1 in commercial formularies, a list of drugs the company maintains to indicate coverage for insured patients.

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DAILY UPDATE: Medicare Advantage Plans Down as Stocks Crash

By Staff Reporters

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Medicare Part C papers, glasses and stethoscope.

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Humana and other managed-care stocks were down sharply in trading Tuesday after the Centers for Medicare and Medicaid Services announced an average 3.7% increase in revenue for Medicare Advantage plans in 2025. That amount is the same as the proposed increase the government had announced in January, but it came as a shock to investors who were hoping for a slight bump.

Humana  (HUM)  shares fell sharply in early Tuesday trading, while rivals UnitedHealth UNH and CVS Health  (CVS)  traded firmly in the red, as the health insurance industry received yet another blow to its 2024 profit forecasts. All three major health insurance groups have trailed the broader market this year, with Humana down nearly 25%, amid concern that profit margins will be hit by a surge in medical costs tied to a rise in elective procedures. Those procedures had been delayed by the Covid pandemic. 

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Here’s where the major benchmarks ended:

  • The S&P 500 index fell 37.96 points (0.7%) to 5,205.81; the Dow Jones Industrial Average lost 396.61 points (1.0%) to 39,170.24; the NASDAQ Composite slipped 156.38 points (1.0%) to 16,240.45.
  • The 10-year Treasury note yield was up almost 3 basis points to 4.357%.
  • The CBOE Volatility Index® (VIX) rose 0.96 to 14.61.

Retailer, biotechnology, and regional bank shares were among the weakest performers Tuesday, leading a broad market slump in which declining stocks outnumber advancers by a greater than three-to-one ratio. The small-cap Russell 2000® Index (RUT) lost 1.8% and settled at a two-week low. 

Energy companies, by contrast, extended recent strength behind an ongoing climb in WTI Crude Oil (/CL) futures, which surpassed $85 per barrel for the first time since late October. The Philadelphia Oil Service Index (OSX) advanced 2.1% and ended at a 5-½-month high. Oil prices have surged this year due to OPEC production cuts and concern over supply disruptions stemming from the Middle East conflict.

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