One of our external agents has been accused by CMS of handling a Medicare case wrongly. What is the right way to do it? What is the wrong day to do it? Also, an update on Wellabe applications and other…
One of our external agents has been accused by CMS of handling a Medicare case wrongly. What is the right way to do it? What is the wrong day to do it? Also, an update on Wellabe applications and other…
Here, we will show the latest guidance on the Annual Election Period and beyond for 2024 with regard to Medicare Advantage and Part D marketing.
Remember, Medicare Supplements do not follow Scope of Appointment or generalized MAPD marketing rules.
See the videos:
On Wednesday, March 18, 2018, Aetna did their first webinar announcing an increase in commissions on Plan N in certain states. Here, in the webinar replay below, you can skip ahead to indicated areas to zero in on the information….
by Leslie Small | FierceHealthcare
Medicare Advantage organizations (MAOs) continue to do a poor job of maintaining accurate provider directories—and it’s landing some in hot water with the federal government.
In its second round of online provider directory reviews, the Centers for Medicare & Medicaid Services found that 52% of the provider directory locations listed had at least one inaccuracy.
Those errors included providers who weren’t at the location listed, providers who didn’t accept the plan at that location, providers who weren’t accepting new patients despite the directory saying that they were, and incorrect or disconnected phone numbers.
When CMS conducted its first review of MAOs’ provider directories, it found that 45% of locations listed were inaccurate. While the report does say that the first and second reviews aren’t directly comparable “due to minor updates to the review methodology,” at the very least, the latest review’s results indicate the problem isn’t getting any better.
CMS also noted that its findings were not skewed by a few organizations but instead were widespread in the sample reviewed, which was about one-third of all MAOs. “Very few organizations performed well in our review,” the agency said.
At a minimum, provider directory errors can make members frustrated with an MAO, the report noted. But they can also cast doubt on the adequacy and validity of the MAO’s network as a whole, and even more seriously, prevent members from accessing services that are critical to their health and well-being.
RELATED: Study takes stock of MA hospital networks
Based on the results of its reviews, CMS has sent 23 notices of noncompliance, 19 warning letters and 12 warning letters “with a request for a business plan” to Medicare Advantage insurers.
However, the agency emphasized that MAOs themselves “are in the best position to ensure the accuracy of their plan provider directories.” It also said it was encouraged by pilot programs aimed at developing a centralized repository for provider data that would be accessible to multiple stakeholders.
In the near term, CMS added, MAOs should perform their own audits of their directory data and develop better internal processes for members to report errors.
See the original article here:
https://www.fiercehealthcare.com/cms-chip/medicare-advantage-provider-directory-errors-network-adequacy
If so, in addition to the AHIP test, there is now another, separate test administered only through CMS and it is required.
This test is on Waste, Fraud, and Abuse, as there always had been in the AHIP test already, but now it's required separately.
Courtesy of United Healthcare, this is a link to the instructions as to how to find and take this simple test:
Excerpt from SeniorAgentPodcast on iTunes:
This is a question that was asked by a new agent this week.
The agent said she had heard that you can lose your license, pay a fine, etc. for cold calling someone about Medicare plans.
What the agent is referring to is the marketing of Medicare Advantage Plans.
You can find the marketing rules from CMS about Medicare Advantage plans here.
However, in most all states, it is perfectly legal to telemarketing / cold call, door knock, and approach seniors about Medicare Supplement plans.
Only one state has restrictions on the marketing of Medicare Supplement plans.
That state is Ohio. Their law prohibits the following for both Medicare Advantage AND Medicare Supplement marketing.
(2) Any of the following unsolicited contacts with a Medicare-eligible person:
(a) Door-to-door solicitation including leaving information such as a leaflet, flyer, or door hanger at a residence, or leaving information such as a leaflet or flyer on someone's car;
(b) Approaching individual prospective applicants in common areas (e.g., parking lots, hallways, lobbies, sidewalks, etc.);
(c) Telephonic solicitation including leaving electronic voicemail messages;
(d) These prohibitions on marketing through unsolicited contacts do not extend to mail and other media (e.g., advertisements, direct mail), or unsolicited contacts with prospective applicants with whom the entity or insurance agent has a business relationship.
Near the end of this podcast, I have several suggestions for various new ways to market Medicare Supplement plans through centers of influence.
Those referenced interviews are found at MedicareAgentTraining.com
Hear the audio of the podcast answer here.
Also on the topic of telemarketing – You CANNOT call folks for Medicare Advantage plans, as said before:
In this briefing, Chris Westfall goes through the Medicare Advantage changes that are now being followed in the media. Seniors considering a Medicare Advantage plan for 2014 should watch this video and see the writing on the wall.
Update since video:
20% of RI docs leave the MA plan:
http://www.providencejournal.com/breaking-news/content/20131022-ri-medical-society-united-is-cutting-20-percent-of-doctors-from-its-medicare-plans.ece
See the video briefing:
References:
http://avalerehealth.net/news/avalere-analysis-reveals-first-drop-in-medicare-advantage-offerings-since-2
http://www.kaiserhealthnews.org/Stories/2013/October/15/medicare-open-enrollment-begins.aspx
https://MedicareAgentTraining.com – for agents only
Seniors should visit: http://SeniorSavingsNetwork.org
This webinar covered ACA changes in store for Medicare Advantage, some Do's and Don't's, and Medicare Supplement comparisons. See the video: Committee Ruling on Medicare Supplements NAIC to HHS Lower Performing MA Plans…
Click on the image to start the video: Despite a block-wide power outage, the show must go on! Today we covered Medicare Advantage in the news and how to zero in with a laser focus on counties where you will…
March 1 Webinar This is a presentation on the results of a comprehensive study looking at the Medicare Supplement industry and senior satisfaction….