Medicare Reduction

PKellogg

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I am trying to find out if it is illegal for a Managed Medicare plan to take the 2% reduction that Medicare has been taking? We had someone new start in our office and she told us that the Managed Medicare plans should not be doing this.
 

CodingKing

True Blue
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You will need to look at your contracts.

CMS Memo:

http://files.ctctcdn.com/fa08d858001/95d7c0f4-2c08-4a77-ac13-f3581ca19ce6.pdf

"Reducing Payments to Contracted Providers
Section 1854(a)(6)(B)(iii) of the Social Security Act prohibits CMS from interfering in the
payment arrangements between MAOs and contract providers.
The statute specifies that CMS
“may not require any MA organization to…require a particular price structure for payment under
such a contract…” Thus, whether and how sequestration might affect an MAO’s payments to its
contracted providers are governed by the terms of the contract between the MAO and the
provider.
We note that MAOs must follow the prompt pay provisions established in their
contracts with providers and to pay providers under the terms of those contracts (see 42 CFR
sections 422.520(b)(1) and (2)). Similarly, the question of whether and how sequestration might
affect a Part D plan sponsor’s payment to its contracted providers is governed by the payment
terms of the contract between the plan sponsor and its network pharmacy providers. We note
that Part D plan sponsors must follow the prompt pay provisions established in their contracts
with network pharmacy providers and to pay the providers under the terms of those contracts
(see 42 CFR sections 423.520(b)(1) and (2))."
 
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