CMS: Errors continue to plague Medicare Advantage plans’ provider directories

Angry Senior on Medicare Advantage

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

2018 Medicare Marketing Guidelines Released by CMS

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)

Source: https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/FinalPartCMarketingGuidelines.html

You can download the PDF here:CY-2018-Medicare-Marketing-Guidelines_Final072017

The text, in its entirety:

<[email protected]@>

Read more 2018 Medicare Marketing Guidelines Released by CMS

New Requirement for MAPD Sales

Do you sell Medicare Advantage plans or Part D plans?

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:

Click here for the document

 

Medicare Supplement Training

Is it legal to call folks about their Medicare plan?

Is it legal to cold call for Medicare plans?

Excerpt from SeniorAgentPodcast on iTunes:

Can I legally call someone and talk about Medicare Supplement plans?

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, that I know of, 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.

Medicare Advantage Plan Reductions Hurting Seniors for 2014

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

http://www.providencejournal.com/breaking-news/content/20131021-unitedhealthcare-dropping-r.i.-doctors-from-medicare-advantage-network-poll.ece

https://MedicareAgentTraining.com – for agents only
Seniors should visit: http://SeniorSavingsNetwork.org

Medicare Supplement Study – March 1 Webinar

March 1 Webinar
This is a presentation on the results of a comprehensive study looking at the Medicare Supplement industry and senior satisfaction.