Some Cut

This blog has closely monitored Medcare Advantage with multiple posts including the strange policy of paying a payor like Humana and UHC more to administer medicare than it costs CMS to administer itself.  Several pundits including many from Congress have suggested cutting medicare advantage reimbursement in order to fund increases to providers or for doing logical things like cutting the cap (or getting rid of that stupid exemption process thing).

So, what do we get?  Instead of a cut, they are increasing their fees by 3.6%!  Isn’t that more than the 1% that we got?

This of course sent Humana’s stock soaring yesterday.

larry@physicaltherapist.com

 

 

Comments

[Mark Schwall, PT]

Larry,
I missed this news until you posted it. I'm simply speechless.

[Selena Horner]

Well, seeing that most Medicare Advantage programs follow Medicare guidelines AND the Medicare fee schedule, CMS perspective might be that if legislation isn't put into place to alter (if I recall correctly) the 10% cut providers are going to have starting July 1, 2008, then that means there will be some cash available to increase CMS payments to administer Medicare Advantage. And of course, those administering the Medicare Advantage programs have to be paid more because administratively an increased cost of changing the electronic database on what providers will be paid is going to need to occur to ensure accuracy of payment to providers in the wonderful, continuous world of dwindling reimbursements to providers.

Actually, reality is that those administering the Medicare Advantage programs probably financially supported someone nicely?

[Mark Schwall, PT]

Selena, It has not been my experience that MC Advantage programs are adhering to the Medicare Physician Fee Schedule but are applying their own "network" fee schedules. In other words, BOHICA. If others are not experiencing this, I would be interested.

[Selena Horner]

In Michigan Medicare Plus Blue and the BCBSM Medicare Advantage programs follow Medicare requirements for physical therapy services and reimburse at the Medicare fee schedule. I can't remember which of those two programs has some odd difference in completing 1500 claim forms. (I'm considered an independent PT and bill for outpatient services on a 1500 claim form.) I have no idea what the Blue Care Advantage program (HMO) reimburses. I haven't chosen to be in-network or participating with that plan at this time.