Medicare Advantage Enrollment Continues to Rise

Medicare Advantage (MA) enrollment in Michigan totaled approximately 1.12 million in October, an increase of 13,000 beneficiaries since July. The October MA enrollment is spread across 45 MA plans that are currently operating in the state, with approximately 49 percent of Michigan’s 2.3 million Medicare beneficiaries covered by an MA plan.

Hospitals are encouraged to carefully review payments from each MA plan to ensure that the plan has paid the correct rates. With up to 28 plans covering beneficiaries in some Michigan counties, a significant burden has been created for hospitals, which may be intensified if MA plans conduct their own audits for medical necessity and other utilization issues.

To assist hospitals in identifying which MA plans are currently operating in their region, the MHA has updated the list of plans in each Michigan county, based on October enrollment.  In addition to the 45 plans currently licensed in the state, Michigan hospitals often treat patients covered by MA plans licensed in other states, further complicating the payment process. Members with questions should contact Kellen Teel at the MHA.

Medicare Advantage Enrollment Continues to Rise

Medicare Advantage (MA) enrollment in Michigan totaled approximately 1,107,000 in July, an increase of 12,000 beneficiaries since April. The July MA enrollment is spread across 45 MA plans that are currently operating in the state, with approximately 48% of Michigan’s 2.3 million Medicare beneficiaries covered by an MA plan.

Hospitals are encouraged to carefully review payments from each MA plan to ensure that the plan has paid the correct rates. With up to 27 plans covering beneficiaries in some Michigan counties, a significant burden has been created for hospitals, which may be intensified if MA plans conduct their own audits for medical necessity and other utilization issues.

To assist hospitals in identifying which MA plans are currently operating in their region, the MHA has updated the list of plans in each Michigan county based on July enrollment. In addition to the 45 plans currently licensed in the state, Michigan hospitals often treat patients covered by MA plans licensed in other states, further complicating the payment process. Members with questions should contact Kellen Teel at the MHA.

Medicare Advantage Enrollment Continues to Rise

Medicare Advantage (MA) enrollment in Michigan totaled approximately 1,095,000 in April, an increase of 22,000 beneficiaries since January. The April MA enrollment is spread across 45 MA plans that are currently operating in the state, with approximately 48 percent of Michigan's 2.3 million Medicare beneficiaries covered by an MA plan. Hospitals are encouraged to carefully review payments from each MA plan to ensure that the plan has paid the correct rates. With up to 26 plans covering beneficiaries in some Michigan counties, a significant burden has been created for hospitals, which may be intensified if MA plans conduct their own audits for medical necessity and other utilization issues. 

To assist hospitals in identifying which MA plans are currently operating in their region, the MHA has updated the list of plans in each Michigan county, based on April enrollment. In addition to the 45 plans currently licensed in the state, Michigan hospitals often treat patients covered by MA plans licensed in other states, further complicating the payment process. Members with questions should contact Kellen Teel at the MHA.

Webinar Reviews Requirements for Upcoming Disproportionate Share Hospital Audits

Myers and Stauffer LC, Michigan’s contractor for the federally mandated Medicaid disproportionate share hospital (DSH) audits, will soon distribute information requests to hospitals for the state fiscal year (FY) 2018 DSH audits. Hospitals that received payments from any of the Medicaid DSH pools for FY 2018, including the hospital provider tax-funded outpatient uncompensated care DSH pool, are subject to these audits.

The MHA is coordinating an educational webinar with representatives from Myers and Stauffer and the Medical Services Administration (MSA) to assist hospitals in completing the audit process. The Michigan-specific webinar is scheduled for 1 to 3 p.m. Feb. 24 and will review:

  • Hospital reporting requirements.
  • Steps necessary for the Michigan Medicaid program to comply with the Centers for Medicare & Medicaid Services (CMS) reporting and audit requirements.
  • Data that will be requested from hospitals that received payments from any Medicaid DSH pool for state FY 2018.
  • Lessons learned from past audits, particularly those for FY 2017.

A draft report is due to the MSA Sept. 30, with the final audit report due to the CMS Dec. 31. The Feb. 24 webinar will feature a formal presentation covering Michigan-specific data requirements followed by a question-and- answer period. Myers and Stauffer encourages hospital staff to review a pre-recorded DSH training that covers general DSH survey instructions and updates prior to the webinar.

No registration is required for the webinar. Hospitals are encouraged to login by 1 p.m. Feb. 24 using the password “MIDSH.” Participation via phone is available by calling (844) 740-1264 and using attendance code 185-802-8641.

Members with questions regarding the DSH audits should contact Kellen Teel or Vickie Kunz at the MHA. For assistance in accessing the webinar, contact Crystal Mitchell at the MHA.