Managed Care Contracting & Provider Payment

Medicare Advantage Plan Network Adequacy: What does a Medicare Advantage Plan have to show? What do Providers Need to Know?

Effective for the 2011 plan year, the Center for Medicare and Medicaid Services ("CMS") has fine tuned its requirement that Medicare Advantage coordinated care plans maintain an “adequate network”.  Providers may benefit from knowing what CMS wants to see.

7 Insurers Agree to Stop Marketing Medicare Advantage Private fee-for-service Plans Until they meet 6 CMS Conditions

An article in the Washington Post reports that:

United Healthcare,
Humana,
WellCare,
Universal American Financial,
Coventry Healthcare,
Sterling Life Insurance Company and
Blue Cross and Blue Shield of Tennessee

have all agreed to discontinue marketing their Medicare Advantage private fee-for-service plans for some period. According to the Post article, these insurers’ plans cover 90% of the Medicare beneficiaries enrolled in Medicare Advantage private fee-for-service plans.

Preparing for Medicare Private Fee-for-Service Plans

I received an interesting question:

“If I’m already participating with an insurance company that launches a Medicare Advantage Private fee-for-service plan, will I automatically be part of that plan?”

For general information about Medicare Advantage Private fee-for-service (“MAPffs”) Plans and how they work, click: HERE