Medicare Compliance & Reimbursement
Who Gets To Keep Medicare Savings: Health Plans Or The Government
President Bush's fiscal year 2005 budget proposal would provide an additional $8.3 billion for Medicare Advantage private health plans from 2006 through 2010 by slowing the move to overall risk-adjusted payments. Since MA plans enroll a slightly healthier-than-average population, Medicare eventually expects to pay MA plans less overall as reimbursement is more heavily adjusted to account for risk.
After slowing the move to risk adjustment several times, policymakers had generally assumed that the government would retain savings reaped from risk-adjusting plan payments from 2006 onward. But in the fine print of this year's budget, the White House says that, instead, it will "phase in over four years the full implementation of savings from risk adjustment" - in other words, continue to return much of the money to MA plans.
The proposal drew mixed reactions from the Medicare Payment Advisory Commission March 10. The panel has repeatedly recommended that risk adjustment be applied to payments as fully and quickly as possible to ensure that Medicare offers accurate reimbursement to those who care for sicker or healthier beneficiaries.
For health plans, "risk adjustment was supposed to have been fully phased in five or six years ago," said Clinton administration Medicare chief Nancy-Ann DeParle. "My concern about all of this is that it just seems to be taking forever to get to what everyone says they agree to, which is a level playing field."
But Urban Institute President Robert Reischauer said, "I'm wondering whether we aren't beating a dead horse here." Reischauer, the commission vice-chair, warned that MedPAC could "get all carried away with our recommendation. ...We want a level playing field. Do it yesterday.
"But maybe what we need to do is pat the president on the back and say, 'Stick with it. Don't back off when [health plans] ... try and get you to postpone it' [again] the way they've done for the last six or seven years."
Medicare Compliance & Reimbursement
- MEDICARE ADVANTAGE:
Who Gets To Keep Medicare Savings: Health Plans Or The Government
Money still headed to MAs, says Prez.
President Bush's fiscal year 2005 budget proposal would provide [...] - PHYSICIANS:
What Reimbursement Will Look Like In The Future
Johnson still pushing for SGR repeal.
At a March 15 hearing, Rep. Nancy Johnson (R-CT) continued [...] - DRUG BENEFIT:
PDP Sponsors Face Pricing Challenges
Projected enrollment tied to national average.
According to information presented by Medicare Payment Advisory Commission staff [...] - LONG-TERM CARE:
SNFs, HHAs May Need System Upgrades
CMS says long-term care industry not ready for new reporting software.
Alert to all nursing [...] - DRUG BENEFIT:
Rx Plans May Target Dual Eligibles
Plans, PBMs looking at automatic enrollees first.
Uncertainty surrounds many facets of Medicare's prescription drug benefit, [...] - PHYSICIANS:
Patients Regained Lost Ground In Medicare Physician Access Struggle
But patients may be getting used to long waits for treatment.
Medicare patients lost the ability [...] - PHYSICIANS:
To Avoid Audits, Show MDM Thought Process
Physicians can improve documentation by following these tips.
A physician's operative notes may have a history [...] - HOME HEALTH:
Outpatient Therapy Loses Home Health Payment Battles
Before treatment begins, ask the patient if he is under HHA care already.
Therapists who treat [...] - COMPLIANCE:
These Expert Compliance Tips Lead To Peace of Mind
Compliance plans can make all the difference - here's how to get started.
In its 2005 [...] - ENFORCEMENT WATCH:
Avoid These Disastrous Supplier Pitfalls
This fraudster's plight shines big and bright ... deep in the heart of Texas.
Durable medical [...] - LABS:
Labs Should Ramp Up Diabetes Screening Tests
Billing at least once per year for all patients now allowed.
The Medicare Modernization Act (MMA) [...] - BILL WATCH
The following bills were introduced in the House:
HR. 1410. A bill to provide for coverage [...]
