| A new policy that informs the public how much money Medicare pays individual doctors may be underway and could violate physicians' privacy rights if poorly handled, warns the American Medical Association.
The Department of Health and Human Services (HHS) has announced that it will start responding to Freedom of Information Act requests for physician-payment data. Government officials will be using a ‘balancing test’ to determine who gets access to the information, and not guaranteeing the data to all filed request. This has prompted groups to say the administration needs to do much more in making payment data broadly accessible and transparent.
Under the FOIA's privacy exemption, some of the doctor’s information may be kept from public view if the damage to physician privacy is deemed greater than the public interest. Disclosure of the doctor’s data will exclude patients information; however, the information released will depend on the outcome of the “balancing test”, which varies by circumstance, analysis, facts, and per case. In all cases, the HHS says they “are committed to protecting the privacy of Medicare beneficiaries.”
In addition, the Center for Medicare & Medicaid will begin “aggregating” data sets about Medicare physician services, 60 days after the new policy appears in the Federal Register.
Disclosure of doctor payment data “from government healthcare programs must be balanced against the confidentiality and personal privacy interests of physicians and patients who may be unfairly impacted by disclosures” says Dr. Ardis Dee Hoven, president of the AMA, who has long opposed the release of data.
Over the past 3 decades, Medicare physician-payment data has been highly sought by media groups, government watchdogs and private organizations. They argue that the disclosure of information informs consumers of a doctor’s competence, performance, and highlights any possible abuse or fraud. The release of information should only be done in the efforts of “improving the quality of healthcare services and with appropriate safeguards,” Hoven said.
Critics against disclosure argue that the release of information would reveal proprietary details the general public does not need to know, and that inaccurate data presentation would damage a doctor’s reputation.
In spite of responding to Freedom of Information Act requests for physician-payment data, the government is not planning to put the entire Medicare physician-payment data online in a searchable format. It will require individuals seeking data to submit specific request under the FOIA’s. Any information that gets released will be filtered and judged by its worthiness, and will take physicians privacy concerns into consideration.
On May 2013 a 1979 federal injunction ruling, that barred the release of Medicare payment data and identified doctor’s specifics, was dissolved by U.S. District Judge Marcia Morales Howard in Jacksonville, Fla., ruling on the grounds that physicians' privacy concerns no longer outweighed the public interest.
Following the ruling, CMS followed suit to and decided to release physician-payment data, citing disclosure under the Freedom of Information Act. Disclosure of the data will be determined on the outcome of the “balancing test,” as a result every case will be treated as an individual basis (FR Doc. 2014-00808).
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Question: Will disclosing physician fees help stop Medicare fraud and save money in the long run or will it have an adverse effect and persuade more physicians to stop accepting new Medicare patients?
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| Big plans to change the way how the private Medicare sector pays brokers and agents are underway and set to appear in the Federal Register on Friday.
The Centers for Medicare & Medicaid Services (CMS), an arm of the U.S. Department of Health and Human Services (HHS), has included the compensation proposals changes in a batch of regulations that deals with the governing rules of the Medicare wellness program, its incentives and the provisions meant to prevent and attack fraud.
The addendum targets current compensation practices of brokers and agents who sell Medicare Advantage plans -- commercial, CMS-subsidized plans that replace traditional Medicare coverage -- and Medicare Part D prescription drug plans.
A yearly “fair market value” limit for producer compensation is what CMS wants, states the proposed regulations.
In 2014, $400 per year may be considered the fair market value. A plan possibly paying a first year commission that was any amount less than or equal to the fair market value limit, officials say.
Commission increase could reach up to 35 percent of the fair market value limit in the following calendar year and the subsequent years. For instance, if in 2014, a producer sold a plan and collected in commission equal to $400, or collected 100% of fair market value, and if the fair market value for 2015 rose to $500, the 2015 year commission would be $175 or 35% of $500 and not 35% of $400 fair market value of previous year, officials say.
Many current plans pay 50% in renewal commission for the first-year commission during policy years two through seven, followed by a 25% of the first-year commission in the later years
CMS goal is to simplify the commission calculations and level out the playing field. The way to do this is by setting all renewal commission to 35% of the fair market value limit, officials say.
To further even out the field, official want to cap out referrals fees at $100 for producers; which, CMS recommended a $100 cap in a memo in 2011.
This recommendation is due to the different ways carriers handle referrals, officials say.
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Question: Will overhauling the Medicare broker compensation even out the playing field, or will it hurt the industry and discourage top producers from reaching or exceeding their goals?
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|As seniors reach 65 many are faced with a lot of questions about their health, health coverage, and the many plans accessible to them. Currently there has been a tremendous enrollment increase for Medicare Advantage (MA) plans or Medicare Plan C as they are known. This growth has been on the rise since 2004, and it currently makes up about 25 percent of traditional Medicare enrollee opting for MA plans, reports the Kaiser Family Foundation. This trend has more the doubled beneficiaries’ enrollment from 5.3 million to 13.1 million in 2012.
According to the Congressional Budget Office, Medicare Advantage enrollment is expected to grow from 14 million, in 2013, to 21 million by fiscal year 2023.
What it means to seniors?
More and more seniors choose to enroll in Medicare Advantage plans because these plans provide comprehensive medical coverage which are of higher-quality care, with better services, and provide additional benefits. These plans are also used by elderly and people with disabilities to cover additional medical expenses that Medicare does not already cover. Additionally, MA plans are more likely to be purchased by healthy seniors than other supplemental insurance options because these policies are more affordable on a monthly basis.
Cost savings is the driving force behind the increased enrollment of Medicare Advantage plans. With Medicare’s Part A, the insured is provided with inpatient hospital care; however, the enrollees are stuck to cover fluctuating deductibles associated with this plan yearly. Part B covers doctor’s expenses and preventive services, such as, flu. Medicare Part C is the Med Advantage plan that covers the additional expenses not covered by both Part A and B plans, excluding End-Stage Renal.
Further savings can be seen with MA premiums. The Kaiser Family Foundation reports that 50% of seniors enrolled in Medicare Advantage plans have no extra premiums, and two-thirds enrolled in the HMO Advantage plans pay nothing extra.
What does this growth mean to private insurers?
Earlier this year the House mandated a proposal that would make payment cuts to MA plans beginning 2014. By law, Medicare Advantage plans are required by law, to lower cost as much as 7 to 8%, and use 85 percent of their revenue on medical care and quality improvement efforts. Those who fail to meet the requirements will be prohibited from accepting new enrollees, and their plans will be terminated after five years of noncompliance.
However, that proposal changed when the Centers for Medicare and Medicaid Services (CMS) decided to increase payments by 3.3 percent. The proposed change could average $50 or more per month for a Med Advantage enrollee. According to the CMS, the change was made to improve program stability and payment accuracy.
Selling Medicare Advantage plans is not as simple as having a basic health insurance license. By law, CMS requires agents, brokers and all licensed sales representatives to complete a CMS certification program before any marketing and selling can be done.
Additionally, with the certification comes responsibility. It is very important for agents to educate enrollees to what exactly the products they are buying.
Another factor private insurer’s face is the CMS Complaint Tracking Module. The CTM is a complaint tracking module used to track the accuracy of incidents and complaints, responses to those complaints and to ensure compliance.
With the advancement in technology, private insurers should embrace the latest technologies to facilitate the response time to any compliance needs. And with the help of their well-trained CMS certified representatives and producers, they should be able to quickly address any concerns or request their clients may have.
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Question: Do you feel that the CMS abrupt change to increase MA payments by 3.3% will further encourage the quality of care seniors receive? Will this help insurers improve CTM compliance?
| The Centers for Medicare & Medicaid Services (CMS) have decided to keep Medicare Part B monthly premiums at bay.
Medicare Part B helps pay for physician services, medical supplies, and other outpatient services not covered by Medicare Part A service plan.
In 2014, the monthly base actuarial rate for seniors’ participants will be $209.80 per month, while those low to moderate-income enrollees will pay premiums at $104.90.
2013 monthly premium levels remain unchanged and the $147 deductible will continue for Part B plans per year.
Less relevant to participants are the Medicare Part A hospitalization premiums, this is highly due to about 99% of Medicare enrollees qualify for Part A coverage without having to pay a premium, says CMS.
In a notice published at the Federal Register, October 30, CMS notice, CMS-8055-N, enrollees that do pay monthly premiums will range between $15 $426 in 2014.
An income-related monthly adjustments amount has been imposed by the Medicare program on beneficiaries with an annual taxable income less than or equal to $85,000 or joint annual taxable income less than or equal to $170,000, is $104.90.
The most a Medicaid enrollee can pay in monthly premium is $335.70, with an annual taxable income greater than $214,000 or joint annual taxable income greater than $428,000.
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Question: Do you think the government will keep Medicare Part B premiums at bay in 2015 or will there be a premium hike?