Medicare Compliance & Reimbursement
2006 MA Pay Hike Not As Steep As Past Years
Medicare Advantage private health plans will get a 4.8-percent per capita payment increase for 2006, the Centers for Medicare and Medicaid Services announced April 4. That's down from the 6.6-percent boost plans got for 2005 and the 10.6-percent update plans got in 2004.
Next year, a new crop of MA plans - preferred provider organizations serving much larger regions, including multi-state areas - will enter Medicare in numbers that are as yet unknown. But 2005 has seen a hefty boost in applications to serve Medicare as "local" plans, which operate on a county-by-county basis. The relatively generous recent annual pay boosts and increased responsiveness by federal regulators to health plans' concerns are credited with the sector's growth.
In 2005, more than 130 new MA plans have begun serving beneficiaries, "including 50 organizations completely new to the Medicare program," according to CMS. Another 96 current participants plan to enlarge their service areas this year.
MA plans are "not just in the big cities any more," said CMS Administrator Mark McClellan at an April 5 hearing before a Senate Homeland Security and Government Reform subcommittee. "Three-fourths of rural beneficiaries will have access to a Medicare Advantage plan" - including so-called private fee-for-service plans, McClellan explained.
Further, "one-third of rural beneficiaries will have access to a coordinated care plan," an "unprecedented" proportion, according to CMS. Some plans will get more than a 4.8-percent pay hike next year. Seventy-five percent of plans' MA payments will be adjusted for patient risk in 2006, up from 50 percent in 2005.
This means that plans enrolling sicker beneficiaries should have an easier time remaining as financially strong as plans with healthier populations.
"We are concentrating Medicare's payments to reward plans that help beneficiaries with complex medical problems prevent complications, through greater access to prescription drugs and care-coordination services," said McClellan in a statement. Plan payments will be 100-percent risk-adjusted in 2007.
In a December analysis, Mathematica Policy Research scholars Lori Achman and Marsha Gold examined the use MA plans made of the enhanced payments Congress has granted them over the past two years as lawmakers attempt to stabilize and expand the program.
Among their findings: Average monthly premiums dropped from $34 to $25, and plans slowed what had been a large-scale shift to generic-only drug coverage.
In addition, average out-of-pocket costs declined. For example, the percentage of enrollees who paid more than $15 for a primary-care physician visit was cut in half - from 22 percent to 11 percent - between January and March 2004. Overall, healthy beneficiaries got more OOP-cost relief than sicker enrollees, Achman and Gold say.
Medicare Compliance & Reimbursement
- Appeals:
Medicare Appeals Changes Coming
Strict new protocols highlight alterations.
If you're a provider who has gotten used to flexibility in [...] - Compliance:
Prove Consults With A Written Request
Safety first: Get some kind of documentation on consult request for patient record.
Last September's transmittal [...] - Compliance:
In-House Consult Forms Make Good Sense
Docs can protect practices with standard consult sheet.
Some consultants do recommend that physicians make their [...] - Physicians:
Incident-to Rule- To Be Or Not To Be?
CMS decides something's rotten in state of Transmittal 20.
Physicians who have been relying on [...] - Disease Management:
Disease Management Demo Projects In Effect
One provider set to sign up 30,000 beneficiaries.
If you are a provider frustrated by dealing [...] - Coverage:
Listen To This Good News About Cochlear Implants
Also, triple-threat drug combo will target nausea and vomiting.
Medicare expanded its coverage for cochlear implant [...] - Hospitals:
Survey- Hospitals Pay Better Than ASCs
Could Medicare save a billion by utilizing ASCs more?
Medicare pays much less for the same [...] - Medicare Advantage:
2006 MA Pay Hike Not As Steep As Past Years
... but MA plans will still get a bump
Medicare Advantage private health plans will get [...] - Medicaid:
New York Plan Could Set National Trend
State passes very fashionable Medicaid proposal.
An influential Medicaid reform plan in the Empire State could [...] - Enforcement Watch:
A Few Bad Apples Ruining It For All DME Providers
DME dealer got wheelchair money - but didn't give her customers wheelchairs.
Despite the continued [...] - Rehab:
Therapists Cheer Physician Self-Referral Scrutiny
Congressional proposals could mean more business for therapists.
Therapy providers who've been losing sleep over physician-owned [...] - Bill Watch
The following bills were introduced in the Senate: S. 708. A bill to amend title [...] - Physicians:
AMA Sounds Alarm Bells Concerning Senior Access
Organization says if Congress cuts payout, docs will cut Medicare patient loads.
Senior citizens will begin [...]
