Managing Medicare » News

CMS Orders 3 Plans to Stop Marketing During 2011 AEP

jbaker — Tue, 23 Nov 2010 16:12:21 +0000

CMS has order three private MA plans to stop marketing and enrollment activity: Universal American Corp. (UAM), Health Net Inc. (HNT) and Arcadian Health. Not a good time to stop enrolling members in the middle of the 2011 AEP!

Further References:

Kaiser Health News

Stockton (Calif.) Record: “These sanctions will remain in effect until each of the three plans demonstrates to CMS that it has corrected the related deficiencies and that those deficiencies are not likely to recur. The actions will not impact the 1 million Medicare beneficiaries enrolled in these health and drug plans” (11/23).

The Associated Press/Bloomberg Businessweek: “Health insurer Universal American Corp. said Monday federal regulators will suspend the company from enrolling new members in its Medicare Advantage plans as an open-enrollment period for the government-subsidized health coverage gets under way. The Rye Brook, N.Y., company said the suspension by the Centers for Medicare and Medicaid Services starts Dec. 5 and is tied mainly [to] agent oversight and market conduct issues. It said it was ‘working diligently’ to resolve the issues as soon as possible” (11/22).

MA Plans Responding to ACA – Retrenchment!

jbaker — Mon, 22 Nov 2010 20:25:03 +0000

According to the WSJ on 11/19/10, the major public MA plans are responding to the legislative changes in the ACA of 2010 by diversifying from the once lucrative private MA business in 2011. Summary:

Private plans are new renewing hundreds of Ma plans displacing over 700,000 lives who must find new coverage options
Kaiser Family Foundation is predicting a 13% decline in MA plans in 2011
The remaining plans are keeping premiums fairly flat with slightly richer benefits – mostly legislated and around preventative care services and expanded drug formularies.
Public companies, like Humana, are predicting 2011 earnings decline of about 16%
2012 – Expect significant changes to both benefits and the players in the market.

ARTICLE in the WSJ

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

VIVA Health, Inc. Selects Dynamic Healthcare Systems Suite

jbaker — Sat, 26 Jun 2010 04:42:18 +0000

FULL DISCLOSURE: I do work for Dynamic Healthcare Systems, but news none the less:

Dynamic Healthcare Systems, a provider of enterprise technology solutions for Medicare-focused health plans, today announced that VIVA Health, Inc., a managed care company with over 32,000 Medicare Advantage members, purchased the Voyager suite including the following modules: Sales/Marketing, Enrollment, Reconciliation, HCC Analytics, RAPS Management and Premium Billing. Dynamic Healthcare Systems is designed to ensure health plans meet the complex compliance and data processing requirements to be properly compensated.

“After reviewing several technology options for managing enrollment and risk adjusted payment, we selected Dynamic’s suite of solutions because they offered the right combination – a comprehensive software solution and expertise in this field,” said Libba Yates, VIVA’s Vice President of Corporate Development. “We value the ability to create an integrated view of our Medicare business and process transactions in a single system.”

The Voyager solutions enable a plan to eliminate compliance risks associated with sales/marketing, enrollment and member management, and risk adjustment requirements by controlling and monitoring operational processes. In addition, plans are able to optimize their premium payments from CMS by correctly, accurately and timely creating, submitting and reconciling enrollment and risk adjustment transactions with CMS.

“To gain a competitive edge today, health plans have to manage and integrate their operations across departments,” said Ken Stockman, Founder and Chief Executive Officer of Dynamic Healthcare Systems. “Voyager is designed to allow plans to eliminate operational barriers between departments and take advantage of the cost and risk reductions and payment optimization that integrated delivery organizations enjoy.”

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.