AJMC August 11, 2022
A recent study found that the largest Medicare Advantage plans pay large markups to large dialysis organizations, and these inflated payments could increase out-of-pocket expenses for patients.
A study conducted at the University of Southern California and published in Health Affairs found that large dialysis chains charge Medicare Advantage (MA) plans 27% more for treatment compared with what they charge traditional, fee-for-service Medicare.
The researchers compared fee-for-service Medicare payments with MA outpatient dialysis spending, using UnitedHealth Group, Aetna, and Humana data. Claim lines with data elements signifying dialysis at outpatient facilities, a type of bill for outpatient dialysis, a Current Procedural Terminology (CPT) code for dialysis, and a revenue center code signifying hemodialysis or peritoneal dialysis were included in the...
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