Managing Medicare » CMS

Obama Appoints New CMS Chief Without Senate Approval

jbaker — Thu, 08 Jul 2010 16:15:08 +0000

Wednesday Barack Obama appointed Dr. Donald Berwick as the Administrator to the Centers of Medicare and Medicaid Services using a recess appointment. Dr. Berwick is a Harvard professor and a patient care specialist. He would be able to serve in his role though next year without Senate approval.

Currently there are no hearings scheduled to review Dr. Berwick’s nomination.

AP NEWS:
http://news.yahoo.com/s/ap/20100707/ap_on_bi_ge/us_obama_health_care_appointment

CMS Updates MAPD and Cost Plan 2010 Reporting Tech Specifications

jbaker — Tue, 06 Jul 2010 15:16:10 +0000

CMS has posted an update their 2010 MA Part C and Cost Plan Technical Reporting Specifications. The update contains clarifications to commonly asked questions from plans.

Part C reporting is a compliance requirement and plans that fail to submit data on time and in good fail will receive a compliance letter and notification.

The updated specification memo can be retrieved from the CMS web site at this location:
http://www.cms.gov/HealthPlansGenInfo/Downloads/PtCReptTecSpecsFinal_06.03.10.pdf

Medicare Advantage Plan Payments Adjusted By STARs Ratings

jbaker — Wed, 30 Jun 2010 15:11:35 +0000

A key change included in the health reform legislation of 2010 was a change to the payment methodology for Medicare Advantage plans. As of today, CMS has not released their policy or the methodology for applying the STARs rating to payment adjustments but the legislation does provide some insights in to the overall approach.

QUALIFIED PLANS
The legislation defines a new plan status as ‘QUALIFIED’ and is eligible for a bonus based on the plan’s STARs rating:

A MA, MAPD, MA Only or PDP plan (PACE are excluded)
Been contracted for at least 3 payment years
LOW ENROLLMENT
- 2012 – All Plans qualify
- 2013 and beyond – A Plan that does not have LOW ENROLLMENT – as defined by CMS
- This is defined as a plan that has for a given payment year a STARS rating of at least ‘4’ or higher.
- Service areas is within a Qualified County

QUALIFIED COUNTY
Plans that operate in services areas that are with in QUALIFIED COUNTIES are eligible for a ‘DOUBLE BONUS’

Population of more than 250,000
As of 12/2009, At least 25% of the Medicare Advantage eligibles are enrolled in a Medicare Advantage plan
The area’s per capita FFS spending is lower than the national per capita spending for a payment year

NO REPORTING
Plans that fail to report on their STARs data will be scored as a 3.5 missing any bonus payments.

RATING CATAGORIES

Summary Rating of Health Plan Quality
- This summary rating gives an overall score on the health plan’s quality and performance on 33 different topics in 5 categories:
Staying healthy: screenings, tests, and vaccines.
- Includes how often members got various screening tests, vaccines, and other check-ups that help them stay healthy.
Managing chronic (long-term) conditions.
- Includes how often members with different conditions got certain tests and treatments that help them manage their condition.
Ratings of health plan responsiveness and care.
- Includes ratings of member satisfaction with the plan.
Health plan member complaints, appeals, and choosing to leave the health plan.
- Includes how often members have made complaints against the plan and how often members choose to leave the plan.
Health plan telephone customer service.
- Includes how well the plan handles calls from members.

CONCLUSION

Know your plan’s STARs rating and create a plan to improve and correctly report the required data to CMS
This is the next opportunity for a plan to be correctly paid by CMS, ignoring this program will introduce financial risk to any plan and offset downward premium adjustments
Be prepared, create a plan and invest in systems to correctly report data to CMS

Be Prepared for Spring 2011 MARx System Upgrades! Will You Be Ready?

jbaker — Tue, 29 Jun 2010 14:33:28 +0000

CMS has planned a major overhaul of their MARx system impacting enrollment file layouts and changes to TRR processing in April 2011. Here is a run down of the changes:

IMPACTED SYSTEM / INTERFACE	DESCRIPTION	FROM	TO
Enroll Disenroll File	Combining transaction codes 60, 61, 62 and 71 in to a single transaction code 61. The file layout will be changed and processing logic will be updated – MAJOR IMPACT	PLAN	MARx
Enroll Disenroll File	Submission Cut-Off Dates are aligning to calendar months, allowing for clear transaction submission based on CMS policy and compliance. – MAJOR IMPACT	PLAN	MARx
Enroll Disenroll File	CMS is creating a new process for canceling enroll and disenroll transactions that have already been submitted to CMS. There will be new transaction types (TC 80- enroll cancel and 81 – disenroll cancel) that will cancel the transaction. CMS will no longer allow for ‘opposite’ transactions to cancel transactions. – MAJOR IMPACT	PLAN	MARx
TRR	New TRCs from CMS will notify the Plan when retro changes to a member’s NUNCMO and LEP have taken place to a member. All plans will receive this information regardles of enrollment dates and withholding status. – MINOR IMPACT	MARx	PLAN
Enroll Disenroll File	CMS will automatically reset a member’s NUNCMO to zero when they turn 65 and enter another IEP for Part D – MINOR IMPACT	MARx	PLAN
TRR	Gone are TRC 165 errors! The processing of enrollment and payment are separated with this CMS upgrade and errors in payment processing will NOT block enrollment processing anymore – no more TRC 165! – MINOR IMPACT	MARx	PLAN
TRR	Daily TRR Files!This is great news. BCSS files will go the way of the dinosaurs and the TRR will be the daily batch response to plan submissions.In addition to faster response the layout will change to include all of the data that was submitted, confirming the values of the submission transaction– MAJOR IMPACT	MARx	PLAN
Enroll Disenroll File	Submit member address changes to CMS using a new transaction code, 76 rather than sending SCC changes to the retroactive processing contractor. – MAJOR IMPACT	PLAN	MARx

All of this and more will dramatically change the way plans report and exchange data with CMS and MARx. These changes are GREAT NEWS for plans that are prepared to move with CMS. The proposed changes will greatly simplify processing rules and improve traceability with data exchanges with CMS. However for those that do not have a plan and resources to execute will be at a great deal of risk.

Will you be ready to meet the new system and compliance requirements by April 2011?

DOWNLOAD THE CMS MEMO HERE.

2.2 Percent Medicare Physician Fee Schedule Update Through Nov 30, 2010

jbaker — Fri, 25 Jun 2010 15:03:20 +0000

On June 25, 2010, President Obama signed into law the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.” This law establishes a 2.2 percent update to the Medicare Physician Fee Schedule (MPFS) payment rates retroactive from June 1 through November 30, 2010. The Centers for Medicare & Medicaid Services (CMS) has directed Medicare claims administration contractors to discontinue processing claims at the negative update rates and to temporarily hold all claims for services rendered June 1, 2010, and later, until the new 2.2 percent update rates are tested and loaded into the Medicare contractors’ claims processing systems. Effective testing of the new 2.2 percent update will ensure that claims are correctly paid at the new rates. We expect to begin processing claims at the new rates no later than July 1, 2010. Claims for services rendered prior to June 1, 2010, will continue to be processed and paid as usual.

Claims containing June 2010 dates of service which have been paid at the negative update rates will be reprocessed as soon as possible. Under current law, Medicare payments to physicians and other providers paid under the MPFS are based upon the lesser of the submitted charge on the claim or the MPFS amount. Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2 percent update rates will be automatically reprocessed. Affected physicians/providers who submitted claims containing June dates of service with charges less than the 2.2 percent update amount will need to contact their local Medicare contractor to request an adjustment. Submitted charges on claims cannot be altered without a request from the physician/provider. Physicians/providers should not resubmit claims already submitted to their Medicare contractor.

Medicare billings now reported on federal Web site

jbaker — Wed, 14 Jun 2006 13:30:02 +0000

By KEVIN FREKING
THE ASSOCIATED PRESS

WASHINGTON – To help Americans become smarter health care shoppers, Medicare this month started publishing a range of what it pays for 30 common procedures and report how frequently hospitals perform them.

The release of the information fits with the Bush administration’s strategy of moving more people into health savings accounts and high-deductible insurance policies. Such insurance policies require people to bear more of their initial medical expenses.

As more people buy such policies, the administration maintains, cost increases would slow because people would work harder to look for the best deal or decide they don’t really need a medical service after all.

The Medicare data – released June 1 – covers such procedures as heart operations, the implant of heart defibrillators and back and neck operations.

The most common elective surgery paid for by Medicare is the replacement of a hip or knee. The government information shows that those procedures cost an average of $11,761. Medicare paid between $9,992-$12,173, on average.

The Pueblo Chiefton

Part D Weely Calls to Be Terminared

jbaker — Tue, 30 May 2006 16:15:52 +0000

Since December of 2005 we have been holding weekly Part D Providers conference calls to address issues physicians and other health care providers were having with Part D. We have seen a gradual decline in the participation on those calls and this past week, we only had one question on the call. To that effect, we are going to hold the final weekly Part D Providers call on May 30th at 2pm EST.

We continue to remain committed to fixing your Part D issues and we are confident that between your email access to us

(PRIT@cms.hhs.gov) and our participation in the Open Door Forums (ODF) you will not feel abandoned. We are asking that physicians and other health care providers take their Part D issues to their respective ODF calls. If you do not currently participate in the ODFs, you are encouraged to sign up to receive the ODF announcements by going to: http://www.cms.hhs.gov/apps/mailinglists/default.asp?audience=4 or http://www.cms.hhs.gov/opendoorforums/

Again, the last Weekly Part D Providers call will occur on May 30th at 2PM EST. The next Skilled Nursing Facilities/Long-Term Care ODFs is June 6th (1-800-837-1935, Reference ID: 8266876) and the next Physician ODF is June 27th. Both will start at 2pm EST.

2007 MA/MAPD Call Letter

jbaker — Wed, 05 Apr 2006 15:22:25 +0000

CMS has released the 2007 MA/MAPD Call letter. Download it here.

Payment Increases to Medicare Advantage Plans Lower

jbaker — Tue, 04 Apr 2006 17:41:49 +0000

CMS on Monday said that reimbursement rates for Medicare Advantage plans in 2007 will increase by only about 1.1% on average, rather than 4% as scheduled, because of a technical adjustment of how physicians code beneficiaries for billing, CQ HealthBeat reports. According to CQ HealthBeat, past small increases in reimbursement rates have led to decreases in benefits offered by Medicare Advantage plans.

Medicare Advantage plans in most cases offer more benefits than traditional Medicare because of higher reimbursement rate increases established under the 2003 Medicare law, in addition to separate subsidies from the federal government for plans that provide prescription drug coverage.

Karen Ignagni, president of America’s Health Insurance Plans, said, “No member of Congress will be able to conclude that plans are overpaid next year.”

Health Plans Don’t Fear 2007 Medicare Advantage Rates, See Positive Long Term

jbaker — Wed, 29 Mar 2006 19:07:26 +0000

CMS is expected to issue final 2007 Medicare Advantage (MA) payment rates April 3. But some established Medicare managed care organizations aren’t holding their breath: They anticipate satisfactory reimbursement for next year’s MA product lines….

Visit AISHealth to read the entire story.