Breaking News: CT Physicians Suing United Healthcare

We recently told you about United Healthcare dropping thousands of Connecticut doctors from its Medicare Advantage plans (see here).  Well, it looks like some doctors have chosen to do something about it.  Two medical associations filed a suit this week accusing the insurance company of breaking Medicare regulations and contracts with its providers.  The associations, comprised of the Hartford County Medical Association and the Fairfield Medical County Association, representing 3,300 doctors, are asking the court to grand an injunction preventing UHC from enforcing its contract amendment.

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Breaking News: United Healthcare to Drop Thousands of CT Docs from its Medicare Advantage Plan

United Healthcare (UHC) will drop more than 2,200 Connecticut doctors from its Medicare Advantage plan in February.  Some speculate that UHC made this change to benefit its rating from the federal Center for Medicare Services which could mean higher reimbursements.  Quality-incentive payments to insurers under CMS’ five-star rating system will become stricter and any plans earning less than four stars will be excluded.  UHC did not confirm these claims, although they did say that they would work with members to find new providers.  Medicaid and Medicare supplement plans are not affected.

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Tiptastic Tuesday: Medicare Beneficiaries and the New Health Law

  • Medicare beneficiaries do not need to apply to the new health law’s exchanges: exchanges are online marketplaces for uninsured individuals and small employers to find coverage. Medicare is not a part of the insurance exchanges.
  • The health law offers new benefits to Medicare recipients such as preventative care services, mammograms, colorectal screening, savings on prescription drug coverage, and by 2020, beneficiaries will be responsible for 25 percent of their prescription drug costs.
  • In the next decade, the health law will cut Medicare spending by $715 billion due to lower reimbursement rates to nursing homes, hospitals, home health agencies and other providers.  It will also cut payments to Medicare Advantage plans to bring the payments closer to what Medicare pays. Officials ensure the spending decrease will not decrease benefits.
  • Medicare recipients with income’s more than $85,000 ($170,000/couple) will pay more for their prescription drug coverage.
  • The House Energy and Commerce Committee, the House Ways and Means Committee and the Senate Finance Committee are working on legislation which would change the “doc fix” (the payment formula Medicare has used to pay physicians) or SGR but as of yet, nothing has been finalized.

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CMS To Increase Medicare Advantage Payments

Swayed by insurers and lawmakers, the Centers for Medicare & Medicaid Services (CMS) backtracked on an earlier plan to cut Medicare Advantage payments to insurers by 2.2% in 2014 and instead decided to give them a 3.3% increase.

Medicare Advantage provides care for seniors who select to receive their Medicare benefits through private insurance plans. About 14 million Americans are enrolled in the program.

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CMS Medicare Enrollment Dashboard

The Centers for Medicare & Medicaid Services (CMS) now has a Medicare Enrollment Dashboard for enrollees that provides a national summary, state demographics and historical trends for Fee-For-Service / Medicare Advantage as well as beneficiary coverage and status.

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Doc Fix, Sequestration Near

Going over the fiscal cliff would result in a 2% cut in payments to Medicare providers and private Medicare Advantage plans under sequestration. And if a “doc fix” isn’t passed along with a fiscal cliff deal, physicians and hospitals would face a 26.5% cut in pay for treating Medicare patients. Other smaller segments of the health industry, such as ambulatory services and rehabilitation therapies, would face cuts, too.

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Hospice Payment System Fact Sheet Now Available

The Centers for Medicare & Medicaid Services (CMS) revised Hospice Payment System Fact Sheet is now available on the CMS website.

The Fact Sheet includes the following information on background, coverage of hospice services, certification requirements, election periods, caps on hospice payments, hospice option for Medicare Advantage enrollees and quality reporting

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CR7821 Provides Clarity for Use in Hospice

The Centers for Medicare & Medicaid Services (CMS) recently released Change Request (CR) 7821 dealing with Advanced Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131. This CR includes revisions to the Medicare Claims Processing Manual, Chapter 30, Section 50 regarding the ABN and provides additional examples for hospices on when the ABN should be given to a patient. Language changes were made to simplify and clarify existing manual instructions.

The ABN is given to beneficiaries enrolled in the Medicare Fee-For-Service (FFS) program.  It is not used for services provided under the Medicare Advantage (MA) program or non-Medicare programs. The effective date of the changes is September 4, 2012.

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CMS Projects $200B In Medicare Savings

The Centers for Medicare & Medcaid Services (CMS) expects the 2010 healthcare-reform law to yield more than $200 billion in savings through 2016 because of measures that include ending excessive payments to private insurers that offer Medicare Advantage plans and implementing new anti-fraud policies. The estimate came from the Office of the Actuary, which also said seniors and others in the traditional Medicare program should see about $59.4 billion in savings during that same period through lower cost-sharing and premiums.

According to the report, lowering excessive Medicare payments to private insurers in Medicare Advantage should save about $68 billion; changing provider payments to improve productivity should yield about $85 billion; and anti-fraud efforts related to the reform law should save about $7.8 billion over the next four years.

Click here to view the report in its entirety.

CMS To Boost 2013 Medicare Advantage & Part D Reimbursement

The Centers for Medicare & Medicaid Services (CMS) has estimated the annual average reimbursement growth rate for Medicare Advantage (MA) and Part D prescription drug plans in 2013 to be 3.07%. The metric measures the estimated growth in per capital expenditures for Medicare beneficiaries. The increase, which goes into effect January 1, 2013 will provide stability for insurers.

The agency also issued policies for the transition of MA benchmarks toward Medicare fee-for-service costs mandated by the Patient Protection & Affordable Care Act (PPACA), and incorporation of plan quality ratings into the MA payment system. It also policies for the transition to fee-for-service-based rates and the quality bonus payments.

To view the Rate Announcement & Final Call letter, click here and follow the link for Announcements and Documents to access to the 2013 files.