Friday, Nov 28, 2014
Health

Medicare: CMS giveth and CMS taketh away


Published:

For all who commented on the Feb. 4 CMS call letter... Medicare Advantage plans did get a minor uptick of about .4 percent. The comment period ended April 7 when the Centers for Medicare and Medicaid Services made the announcement. Many plans regarded this as a token because overall cuts are estimated at slightly over -3 percent. This is in addition to the recent 6 percent cuts. So the actual cuts were less for 2015, but the problem is that carriers might not be able to push providers down any farther to get the cuts to work. These cuts may have to come out of the benefits according to John Gorman, founder of Gorman Health Group, a consulting firm to Medicare Advantage plans.

Advantage Plans have two more dark years until 2017 when plan increases will be linked to the increases in fee-for-service Medicare at which time both programs will move forward. Medicare - despite reforms and competitive bidding - still suffers from "code creep" that CMS knows about but has yet to resolve.

The final report gave a reprieve to carriers using "home visits" to increase or regurgitate the illness intensity coding to get increased payments. CMS still wants the use of these visits to be clinically meaningful and resulting in a plan of care.

Advantage Plans now will be required to give a 90-day notice prior to terminating providers, which was another addition.

So that is the final word for what is becoming the annual two step between CMS and the carriers.

In other news, on March 31, Congress did its 17th patch of the "Doc Fix" for one year, another annual rite of spring. Had it not passed at the last minute original Medicare fees to doctors would have been cut 24 percent

Lastly, I want to remind readers that last year, on April, 1, Medicare cut payments to physicians by 2 percent due to the sequestration, but doctors were not allowed to balance bill Medicare patients for the 2 percent of lost revenue. We still have no guidance from Medigap insurance plans on whether they will adjust payments to physicians to make up the 2 percent in reductions.

Betsy Vipond is CEO of The Senior Health Advisor and has been in insurance for more than 38 years. She is a board member of Tampa Bay Health Underwriters part of the National Association of Health Underwriters and specializes in Medicare products. You may contact her at (800) 603-0901.

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