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 Servicesfoundthat 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.
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:
The 2018 marketing guidelines for Medicare Advantage and Part D drug plans have now been released.
In it, CMS addressed the proposal of cutting out the FMO's when distributing MAPD and Part D drug plans, deciding to leave in the provision where they can make overrides (See 120.4.4).
Also addressed, individual agent websites do not have to be submitted to CMS for specific approval, so long as they are not misleading and they do not specify plans or benefits. They do still, however, have to be approved by the actual plan sponsors (MAPD or Part D companies). (See 100.7)
Today it was officially announced that CIGNA and Anthem have struck a deal to become, for now, the largest health insurer in America. The terms of the final deal finally having weathered the storm of a two-month long negotiation, the deal is said to be worth $48 Billion to CIGNA for its acquisition into Anthem.
The independent market is still waiting to hear how this will impact the Medicare Supplement and Medicare Advantage distribution channels. The deal might take two years to get through regulator's approval.
As always, we'll have the specific news when it's available as to how this will impact the individual agent. – Stay tuned!
CMS is gearing up to release the 2016 funding levels on February 20th, 2015.
Last year, there was a lot of intense lobbying in Congress after the first set of numbers were released, then they were changed due to these lobbying efforts.
What will happen this year? Speculation ranges from .8% increase, by JP Morgan Chase, up to 2% increase by other industry watchers. Medicare Advantage rates are not just driven by the needed numbers. Moreso, the increase or decrease is driven by politics.
A report from PublicIntegrity.org details new, and not-so-new investigations into Medicare Advantage potential fraud and abuse around the country. In multiple states, and across providers, Congress is trying to get a handle on the overpayments that are happening with this managed care approach to replacing original Medicare.
“The Obama team has made a warm embrace of managed care options when it comes to Obamacare and Medicaid. But for Medicare, they want to deny low-income seniors these options. All of the administration's old arguments on why they resisted these private Medicare plans have been largely mooted, or never materialized.”
The Forbes.com article goes on to site a study that says at least 13% of Medicare Advantage plans expect to be eliminated by 2015. The agent in the Medicare market must strongly consider having a deeply rooted anchor in the Medicare Supplement market, as we do.
As always, I'll continue to keep you updated on the changes and opportunities in this awesome marketplace, here on MedicareAgentTraining.com.
On the Friday webinar for members, held January 3, 2014, I laid out the predictions from all of the experts on the decline for Medicare Advantage business in the near future. This is for a variety of reasons, not the least of which was the shenanigans employed by the president just prior to the election, where Medicare Advantage would be propped up to shield seniors from the cuts in the ACA – until just AFTER the election. See the webinar on this topic here:
Today, an article was written by Bloomberg pointing to the same conclusion.
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.
Today, another news story covers the impact seniors will feel next year from the Obama Administrations cuts to Medicare Advantage.
We strive to let seniors know of the benefits and freedoms affordable by a Medicare Supplement plan.
This is in sharp contrast to the limitations, restrictions, and now, higher prices they will see on Medicare Advantage for 2014. -CW
Obama Administration Plans to Cut Medicare Advantage Reimbursements
(CNSNews.com) – The Obama administration is planning new cuts to Medicare, a federal regulatory filing reveals, cuts that could mean higher premiums or seniors losing their coverage altogether.
The new cuts come in the form of a planned reduction in the reimbursement rates the government pays to insurance companies that operate Medicare Advantage plans, which are services administered by private for-profit or non-profit providers that offer additional services than can be found in traditional Medicare.
CMS said it was cutting payments because it foresaw the overall costs of the Medicare Advantage program shrinking by 3.2 percent, despite the fact that health care costs – the driver of all federal health care program costs – are only rising.
Medicare Advantage is like traditional Medicare except that its plans are administered by insurance companies, who are paid a per-enrollee reimbursement fee by the government. If insurance companies can provide care to seniors at less than what the government pays them for it, they make a profit.
Medicare Advantage provides coverage for approximately 28 percent of all Medicare beneficiaries, offering them higher-quality services and additional benefits, such as vision and dental care, than the traditional government program at slightly higher cost.
The Obama administration already plans to cut the Medicare Advantage program by $200 billion as part of Obamacare. However, the proposed reductions it announced in February are new, and will cut the program in addition to the planned $200 billion in Obamacare cuts, most of which are delayed in 2014.
The new cuts are also scheduled to go into effect in 2014, but as a function of the normal rate-setting process for that year, not a political effort to delay financial pain for seniors past an important election, as apparently was the case with the original Medicare cuts that Obama signed.
In its regulatory announcement, the CMS said it was assuming that reimbursement payments in traditional, government-run Medicare will be cut, and cited that as justification for cutting Medicare Advantage.
However, while those cuts to traditional Medicare have been set into law for more than a decade, Congress has never allowed them to happen, instituting what is known as the Doc Fix every year, to keep reimbursement payments the same.
Senator Marco Rubio (R-Fla.) wrote to the CMS urging them to consider political reality and reverse their planned Medicare Advantage cuts.
“This assumption is highly problematic because – even though it almost certainly will turn out to be wrong – it translates into lower funding to support the health benefits of the 14 million Medicare beneficiaries who are currently enrolled in MA [Medicare Advantage] plans,” Rubio wrote on March 8.
In other words, if the Obama administration continues with its proposed new Medicare cuts, some or all of the 14 million seniors who get health care through the MA program could be negatively affected, that is, paying higher premiums or possibly losing coverage.
This is because the proposed cut could make the program unprofitable for insurers, who would be forced to either stop offering MA plans or pass the increased costs on to seniors in the form of higher premiums.
One health insurance provider told its shareholders that the proposed rate cuts could mean the end of Medicare Advantage all together.
“There are going to be some markets that at these rates, if they go the way they’re going, it’s going to be very hard for Medicare Advantage to survive,” Universal American Corp CEO Richard Barasch said in a February 19 conference call with shareholders, the industry publication Health Plan Weekreported.
“I think it’s going to be sort of a market-by-market, company-by-company exercise,” Barasch said.