APMA News - January/February 2025 - 19
Medicare Part B enrollees have decreased significantly
from 2016 to 2021, and he also noted the
expansion of Medicare Advantage (MA) programs
across the country.
APMA private insurance consultant Kelli Back,
Esq., provided attendees an update on ongoing
issues and trends for MA and commercial plans.
In 2024, approximately half of Medicare-eligible
patients were enrolled in MA plans. This year also
saw numerous regulatory changes. It was the first
year for Medicare Advantage Organizations (MAOs)
to implement new rules around utilization management
and prior authorization changes. MAOs will
only require authorization for verifying diagnosis
or other medical criteria. If there are denials, those
who do these reviews are not required to be in the
same specialty but must have reasonable medical
knowledge.
During the meeting, attendees broke into
discussion groups to talk about common issues.
Major areas of concern in the public insurance
arena include lingering complications that
require redetermination for repeat CPT 11730/
CPT11750 procedures and challenges with reimbursement
related to nail trimming and debridement,
corn and callus removal, and E/M services.
Relative to MA and private payers, common
issues discussed included denials or reimbursement
reduction for claims billed with the -59 or
-25 Modifiers, DME audits, prior authorizations,
and skin substitutes.
During the meeting, Jodie Sengstock, DPM, was
elected to serve as the next CAC chair. She succeeds
Theresa Hughes, DPM, who served for the
previous two years. Additionally, the Franklin Kase,
DPM, Memorial CAC-PIAC Representative of the
Year Award was presented to Janet Simon, DPM,
for her hard work and dedication to her profession,
her unfailing support in promoting CAC and PIAC
issues, and in her efforts to promote public health.
The meeting also included time dedicated to
discussing the roles and responsibilities of CAC and
PIAC representatives.
To read more outcomes from the meeting as
well as view recordings, presentations, and notes,
visit www.apma.org/cacpiac2024.
APMA.ORG
The attendees at
the recent CACPIAC
meeting
take a break from
reimbursement
issues to pose for
a group photo.
Inset: Breakout
groups allow
participants time
to share concerns
and strategies.
apmanews
19
http://www.apma.org/cacpiac2024
http://www.APMA.ORG
APMA News - January/February 2025
Table of Contents for the Digital Edition of APMA News - January/February 2025
Contents
APMA News - January/February 2025 - Cover1
APMA News - January/February 2025 - Cover2
APMA News - January/February 2025 - 1
APMA News - January/February 2025 - 2
APMA News - January/February 2025 - 3
APMA News - January/February 2025 - Contents
APMA News - January/February 2025 - 5
APMA News - January/February 2025 - 6
APMA News - January/February 2025 - 7
APMA News - January/February 2025 - 8
APMA News - January/February 2025 - 9
APMA News - January/February 2025 - 10
APMA News - January/February 2025 - 11
APMA News - January/February 2025 - 12
APMA News - January/February 2025 - 13
APMA News - January/February 2025 - 14
APMA News - January/February 2025 - 15
APMA News - January/February 2025 - 16
APMA News - January/February 2025 - 17
APMA News - January/February 2025 - 18
APMA News - January/February 2025 - 19
APMA News - January/February 2025 - 20
APMA News - January/February 2025 - 21
APMA News - January/February 2025 - 22
APMA News - January/February 2025 - 23
APMA News - January/February 2025 - 24
APMA News - January/February 2025 - 25
APMA News - January/February 2025 - 26
APMA News - January/February 2025 - 27
APMA News - January/February 2025 - 28
APMA News - January/February 2025 - 29
APMA News - January/February 2025 - 30
APMA News - January/February 2025 - 31
APMA News - January/February 2025 - 32
APMA News - January/February 2025 - 33
APMA News - January/February 2025 - 34
APMA News - January/February 2025 - 35
APMA News - January/February 2025 - 36
APMA News - January/February 2025 - 37
APMA News - January/February 2025 - 38
APMA News - January/February 2025 - 39
APMA News - January/February 2025 - 40
APMA News - January/February 2025 - 41
APMA News - January/February 2025 - 42
APMA News - January/February 2025 - 43
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APMA News - January/February 2025 - 50
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APMA News - January/February 2025 - 53
APMA News - January/February 2025 - 54
APMA News - January/February 2025 - 55
APMA News - January/February 2025 - 56
APMA News - January/February 2025 - Cover3
APMA News - January/February 2025 - Cover4
APMA News - January/February 2025 - A1
APMA News - January/February 2025 - A2
APMA News - January/February 2025 - A3
APMA News - January/February 2025 - A4
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