Your Weekly Medicare Consumer Advocacy Update
New Data Show How Much Doctors Are Paid by Medicare
CMS Releases Data on Medicare Payments to Doctors
This week, the Centers for Medicare and Medicaid Services (CMS) released 2012 Medicare data on how much doctors were paid for Part B (outpatient) services provided to Medicare beneficiaries. According to the CMS press release, the data “allows comparisons [of Medicare claims paid to physicians] by physician, specialty, location, the types of medical service and procedures delivered, Medicare payment, and submitted charges.” This data only shows claims from doctors who billed Original Medicare Part B (outpatient) services, and does not include Part A (inpatient) billings or claims sent to Medicare Advantage plans.
The CMS press release states that it is making this data public as part of an effort to make the US health care system more transparent. Last year, CMS also released data on hospital charges for common inpatient and outpatient services. However, according to a Washington Post article, many doctors urge caution when looking at the newly released data. They argue that it shows the payments, but not the overall profits they earn for these procedures after covering costs for supplies, staff, and overhead.
Overall, despite some concern of misinterpretation, there is hope that the release of this data will be a positive step towards health care system transparency. It may help Medicare beneficiaries identify which doctors they would like to see, help regulators more easily identify fraud, and more.
Medicare Advantage and Part D Rule Changes Released by CMS
This week, CMS also released the Medicare Advantage (MA) and Part D rate announcement and final call letter for 2015. The final call letter represents changes and updates to MA and Part D plans for next year, and is the final result of an annual update process, which includes CMS’ consideration of public comments on the proposed changes—including those of the Medicare Rights Center.
Key changes for next year include:
- Lower Out-of-Pocket Drug Spending: Because of the Affordable Care Act, the Part D coverage gap, also known as the doughnut hole, will continue to close. In 2015, those who reach the coverage gap will receive a 55% discount on brand name drugs—up from 52.5% in 2014—and a 35% discount on generic medications—up from 28% in 2014.
- Increased Protections for Beneficiaries Affected by Changes in MA Plan Networks: In 2015, plans will be required to provide CMS 90 days notice of any significant changes in their provider networks. Additionally, a policy will be established to allow beneficiaries the opportunity to change plans if they are affected by major provider network terminations by an MA plan in the middle of the year without cause.
- Payments to MA Plans: CMS will increase the overall payment rate to MA plans by 0.4% in 2015. Individual plan payments will continue to vary based on multiple factors, including location and star rating.
Volume 5, Issue 14
If you have been denied coverage for a health service or item, you should appeal this decision. An appeal is when you ask Medicare or your plan to reconsider its coverage decision. You can appeal whether you have Original Medicare, a Part D prescription drug plan, or a Medicare Advantage private plan. However, the appeal process is slightly different depending on what service or item you are appealing and how you receive your Medicare benefits.
No matter what service or item you are appealing, you should fully read all the letters you receive from Medicare or your plan. You should also take detailed notes about who you talk to, when you talk to them, and what they say. Also, you should remember that there is always more than one level of appeal. If you are not successful with the first level of appeal, you should not get discouraged. Continue to the next level of appeal. Many people are successful at the upper levels of appeal.
A recent infographic in the Kaiser Family Foundation series, “Visualizing Health Policy,” looks at payments to Medicare physicians and beneficiary access to providers who accept Medicare. There is plenty of good news for people with Medicare. For instance, 88% of beneficiaries report always or usually being able to schedule a doctor’s appointment and 9 in 10 physicians accept new Medicare patients.