Why is Medicare Advantage Monitoring Necessary?

Medicare Advantage plan, or Medicare Part C, is a type of health insurance plan that provides Medicare benefits and, in many cases, additional benefits that are not covered in the Original Medicare (Parts A and B).

If you are a healthcare facility offering Medicare Advantage plans, your sponsor will require you to routinely monitor your facility’s compliance. It is essential to provide evidence of the Medicare Advantage monitoring to your sponsor.

A Medicare compliance expert can help you develop procedures to monitor your compliance issues. It can include routinely evaluating your organization’s employee training for safe and effective clinical practices. With the increasing popularity of Medicare Advantage plans, here is why Medicare Advantage monitoring is necessary:

• Quality of Care

Medicare Advantage plans are required to meet specific standards set by the federal government. Monitoring these plans helps ensure that the quality of care provided to beneficiaries is maintained and regularly improved over time. It is especially important for beneficiaries with chronic conditions or needing ongoing medical care.

• Cost Savings

Medicare Advantage monitoring also helps identify areas where cost savings can be achieved. For instance, plans may be able to negotiate lower prices for medical services or prescription drugs, resulting in lower out-of-pocket costs for beneficiaries, making healthcare more affordable.

• Improved Health Outcomes

Monitoring Medicare Advantage plans can pinpoint areas where health outcomes can be improved. For instance, plans may be able to offer more preventive care services, such as wellness visits and screenings, which can help prevent serious health problems from developing.

• Protection of Beneficiary Rights

Medicare Advantage plans must follow certain rules and regulations set by the federal government. Monitoring these plans helps ensure that beneficiaries’ rights are protected and that plans comply with these rules. It includes protecting beneficiaries from discriminatory practices, such as denying coverage based on pre-existing conditions.

• Transparency and Accountability

Medicare Advantage monitoring helps ensure that these plans are transparent and accountable. Monitoring provides beneficiaries with clear information about the benefits and services provided by the plan, as well as the costs associated with these services.

Conclusion

Regular Medicare Advantage monitoring is necessary to ensure that beneficiaries receive the best possible care and have access to the services they need.

Monitoring also helps ensure that plans are cost-effective, transparent, and accountable. By working together, the government, private health insurance companies, and beneficiaries can ensure that Medicare Advantage plans continue to provide quality care and support to beneficiaries.