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.
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.
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.
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.
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