Humana has informed congressional staffers that it supports measures to limit billing practices that result in billions of extra payments to the industry. The company expressed willingness to endorse new restrictions on payments insurers can obtain from diagnoses recorded by nurse practitioners who visit enrollees in their homes. This was outlined in a policy overview shared with the staffers.
Nearly half of the 65 million people covered by Medicare are enrolled in Medicare Advantage plans, which private insurers manage. These insurers receive a set rate for each patient but can earn additional payments for patients with multiple health conditions. Last fall, staff working for Senators Mike Crapo and Ron Wyden, the leaders of the Senate Finance Committee, approached Medicare Advantage insurers for suggestions on legislative actions to address the potential misuse of home visits.
In February, it was reported that the U.S. Department of Justice was investigating UnitedHealth’s practices for recording diagnoses that resulted in additional payments to its Medicare Advantage plans.
Humana backs Medicare billing restraints
UnitedHealth stated it was unaware of any new probe at that time.
There has been detailed coverage over the past several months about how UnitedHealth benefited from exploiting Medicare billing rules. Humana is recommending restrictions on payments for diagnoses made during nurse practitioner home visits and opposing compensation for diagnoses derived from medical chart reviews that lack direct patient interactions, according to forecasts from 22 analysts.
Humana Inc. has an average one-year price target of $302.33, with a high estimate of $402.23 and a low estimate of $260.00, suggesting a potential upside of 30.17% from the current trading price of $232.26.
The consensus from 27 brokerage firms gives Humana Inc. an average recommendation of 2.6, which is categorized as a “Hold” on a scale where 1 indicates a “Strong Buy” and 5, a “Sell.”
Humana’s push for billing reforms is seen as a move to bring more accountability and efficiency to Medicare payment practices.