Medicare Compliance & Reimbursement

Plans hopeful Congress will deliver on Medicare reform, funding increases.  Things may be looking up for the Medicare+ Choice program. The American Association of Health Plans announced Sept. 8 survey results showing that fewer plans will be exiting the program next year than in any of the previous six years in which AAHP has conducted the survey. M+CO exits should affect roughly 40,000 enrollees, a stark drop from last year, when the survey predicted that exits would affect nearly 190,000 enrollees. "This is a strong statement that plans are doing whatever they can to offer choices to seniors," said AAHP President and CEO Karen Ignagni in a conference call with reporters. More significantly, AAHP's survey also asked plans if they would expand their Medicare+Choice offerings if Congress came through with increased funding - and an overwhelming number said "Yes." Increased funding could not only preserve the fragile program, but give it a jolt of adrenaline so it can reverse its long trend of enrollment cuts. "There is an opportunity for Congress to get value from an investment this year," Ignagni said. Her focus on "value" seems to be an implicit acknowledgement of Congress' severe budget constraints. In the current economic climate, it may be difficult for plans to get any money from Congress, so AAHP is hoping to sweeten its request by arguing that any money given to the Medicare program will more than pay for itself through plans' increased efficiencies and cost-saving methodologies. "Plans have proven tools that can be deployed" to save money for Medicare, Ignagni said. She also argued that the survey results put pressure on Congress to act now. Representatives just spent the summer recess hearing their constituents' calls for Medicare reform, Ignagni said. That, combined with the survey's findings and the fact that the House and Senate have both passed Medicare reform bills, makes this the best opportunity M+COs have had in years to finally win increased funding. And because it's possible Congress could increase funding in the coming weeks - after the deadline for plans to file for M+C in 2004 - AAHP has been speaking with congressional representatives about the possibility of plans refiling and expanding their M+C offerings after the deadline. That way plans that decide to opt out now but learn six weeks later that the economic landscape has changed could be allowed to reverse course and stay in the program. But this would all depend on how quickly Congress acts, Ignagni said. If funding isn't increased until December, that could be too tight a timeline for plans to rethink their strategies.

Optomistic Plans Seek Results From Congress  The number of withdrawals has decreased because plans are doing whatever they can to [...]