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Huh? This appeared on my EOB regarding payment to my gastro for an office visit. Never saw this 2% reduction rate before but it says CMS is doing this after April 1 to MA providers who use the Medicare rates for billing. What???
So, just the Advantage Plan members are getting their payments to their providers reduced? If I were a Medicare provider, I would stop taking Advantage patients. I have gathered the best physicians to care for me and I suspect they will be dropping me soon.
Can someone explain if this is Obamacare? Anyone else notice this on a recent EOB? I am disgusted cause this is one of the very best docs I have ever had.
Congress imposed sequestration on itself in order to force agreement among opposing parties on getting the budget in line. Clearly, that strategy failed.
Due to the sequester, federally-funded unemployment benefits have been cut in every state ranging from 10.7% to 22.2%, depending on the state and when it began cutting payments to claimants.
Government employees at both federal and state levels have been laid off as a result of sequestration.
Defense and many other branches of govt have been and will be experiencing cuts/layoffs.
All that said, this is the first I've heard of Medicare payments being cut because of sequestration. Not surprised, however.
Keep in mind, Advantage is private health insurance administration of Medicare benefits, for which the Advantage carrier is paid a huge sum every month - $700 per enrollee. These insurance companies have always begged for people to join these plans because Advantage is a HUGE CASH COW for the insurance industry.
The Advantage insurance carriers have been overpaid for years and should be bearing these cuts - not the medical providers.
For now, sequestration cuts are scheduled to end September 28th. After that normal payments should resume. Of course, if Congress is still in a stall on budget issues, that can change.
Hey thanks for that explanation. Should I be questioning Healthnet Medicare about this and propose that they stop reducing payments to providers by 2%? I do not want my docs to drop me because of this. It took alot of research and time to set up docs who are knowledgeable, compassionate and caring about my numerous medical problems. Breast cancer, esophagitis, Barretts, degenerative disc disease, arthritis, hypertension, Hashimoto disease, cholesterol over 300, and it goes on and on. I have found the very best physicians in the Phoenix area and want them to continue to monitor my health. Any way my comments to Healthnet would matter, just in case this doesn't end in Sept.? Thanks again.
Hey thanks for that explanation. Should I be questioning Healthnet Medicare about this and propose that they stop reducing payments to providers by 2%? I do not want my docs to drop me because of this. It took alot of research and time to set up docs who are knowledgeable, compassionate and caring about my numerous medical problems. Breast cancer, esophagitis, Barretts, degenerative disc disease, arthritis, hypertension, Hashimoto disease, cholesterol over 300, and it goes on and on. I have found the very best physicians in the Phoenix area and want them to continue to monitor my health. Any way my comments to Healthnet would matter, just in case this doesn't end in Sept.? Thanks again.
Assuming your providers have a contract with Healthnet, then YES, you should contact the company. You should also consider providing a copy of this CMS memo to your providers, if needed. http://www.mha.org/mha/weeklymailing..._sequester.pdf
In short, Healthnet cannot pass on the 2% reduction to the providers unless the contract between Healthnet and the providers allows for such a reduction.
If you watched the markup of the healthcare bill it included 500 billion Medicare cuts over 10 year as part of funding the healthcare bill. They clearly debate and made clear the intent of part of savings to pay for that was thru elimination of extra payments to advantage plans providers. Since its over ten years likely it will slowly be eliminated and its put to advantage plans how they deal with it; of course.
It's not advantage plans. The sequestration cuts apply to all Medicare payments to providers. Because of that, it shows on your advantage remittance advice. Calling your advantage plan won't change it.
Another little tidbit; if congress doesn't pull their head out the sequestration will cut payments to providers by 24% as of 1/1/2014. Good luck finding a provider after that. http://www.medscape.com/viewarticle/779980
Quote:
That legislation, the American Taxpayer Relief Act, also delayed a 26.5% Medicare pay cut until January 1, 2014, and sequestration was delayed until March 1 of this year.
Sequester does not include Medicare as its one of programs exempted from sequester cuts. Read the Medicare trustee report from last year on cuts and then realize that 500 billion was cut from Medicare to fund the new healthcare law. Its being used for the pre-existing coverage subsidizing to insurance company as of last year. Its the offset from saving by elimination of extra funding to advantage plans over fee for service over those ten years. Its in the scoring of the bill which basically shows now it will be funded so as to meet senate rules.
Sequester does not include Medicare as its one of programs exempted from sequester cuts. Read the Medicare trustee report from last year on cuts and then realize that 500 billion was cut from Medicare to fund the new healthcare law. Its being used for the pre-existing coverage subsidizing to insurance company as of last year. Its the offset from saving by elimination of extra funding to advantage plans over fee for service over those ten years. Its in the scoring of the bill which basically shows now it will be funded so as to meet senate rules.
This is not true. The $500 billion is separate and apart from the sequester cuts.
Medicare providers are subject to the 2% sequester cuts.
Just Google "sequester cuts to medicare providers" and you will find links to all sorts of recent - within past two months - articles on the cuts, including links to Kaiser and CMS.
Indeed, the sequester cuts to Medicare providers - not only those in Advantage plans - is real.
Quote:
Originally Posted by chele123
It's not advantage plans. The sequestration cuts apply to all Medicare payments to providers. Because of that, it shows on your advantage remittance advice. Calling your advantage plan won't change it.
Another little tidbit; if congress doesn't pull their head out the sequestration will cut payments to providers by 24% as of 1/1/2014. Good luck finding a provider after that. http://www.medscape.com/viewarticle/779980
Thanks for that information. I hadn't paid attention to how sequester was affecting Medicare. Don't doctor, never thought about it.
It's not advantage plans. The sequestration cuts apply to all Medicare payments to providers. Because of that, it shows on your advantage remittance advice. Calling your advantage plan won't change it.
Another little tidbit; if congress doesn't pull their head out the sequestration will cut payments to providers by 24% as of 1/1/2014. Good luck finding a provider after that. http://www.medscape.com/viewarticle/779980
Recap: The 2% reduction is applied as follows:
The 2 percent cut to Medicare payments applies to provider payments for services administered under Medicare Hospital Insurance (Part A), Medicare Medical Insurance (Part B), the contractual payments to Medicare Advantage Plans (Part C), and Medicare Prescription Drug Plans (Part D). Part A and Part B cuts will be made to each individual Medicare payment. Part C and Part D cuts will be implemented through the monthly payment from Medicare to the private plans that administer these programs. http://www.aei.org/article/health/en...oss-providers/
Nowhere does it state that the Advantage plans are allowed to reduce the providers' payments. Indeed, the CMS memo in my earlier reply directs that the Medicare Advantage Plans cannot pass this reduction on to the providers unless the Plan's specific contract with the provider allows for it.
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