beginning in 2016, the federal government will require health insurance companies to give all Americans enrolled in Medicare Advantage plans, or plans that were bought in the race health exchange , the current details of which doctors participate in the federal plans and those taking new patients. 
keeping Directories Doctor Update
This is good news because in its current form, the plans Medicare Advantage and most exchange plans limit coverage to a network of doctors, hospitals and other health care providers who are subject to change during the year. Therefore, it is not always easy to determine who is in or out of network. In addition, many consumers have complained that their health coverage is useless if they are unable to find doctors willing to accept their insurance
Because of new rule published in February 2015 the Centers for Medicare & Medicaid services, Medicare Advantage plans are required to communicate with doctors and other providers every three months to update their directories online " real time". online directories for policies sold by healthcare.gov , the insurance Bourse disease managed by the federal government in 37 states, will be updated monthly, CMS said in a separate document ad .
How inaccurate directories create problems
A remarkable detail about the new rule is that inaccuracies in the Medicare Advantage directories can trigger penalties of up to $ 25,000 per day per beneficiary, or even bans of new listings and marketing. CMS also plans to use these directories to determine whether insurance companies have enough doctors to meet the needs of its beneficiaries. In addition, federal trading schemes could face penalties of up to $ 100 per day for problems in their directories.
These changes were implemented as a direct result of the big mistakes that litter these directories. "Studies have shown the rate of massive errors in these directories, including states in the federal exchange," said Lynn Quincy, associate director of health policy at Consumers Union. "If consumers choose a health plan because they believe that their hospital or doctor is a participating provider and turns later that was a mistake, now they rarely a cure, they are stuck with that plan for 'year."
In addition, regulators rely on supplier directories to determine the suitability of the operation regarding the network. If, for example, directories always reflect physicians who have moved out of state, died or are not accepting new patients, the network ceases to be sufficient, thus creating problems for beneficiaries. The new rules of Medicare Advantage are a direct response to complaints from beneficiaries and doctors.
Californians had difficulty to find doctors in their plans and others received inaccurate information. The people have been deceived into thinking their suppliers were networked, but were charged a "non-network" rate. Because of this, a emergency regulation was published, requiring plans to update their weekly directories.
Mixed reactions were expressed regarding the new rules for Medicare Advantage plans. There are concerns about the increased cost of compliance. Matt Burns spokesman UnitedHealthcare, one of the largest providers of Medicare Advantage, said the company is still reviewing the rules. Other companies seek clarification Health Insurance Plans America.
"It is important to keep in mind that the maintenance and accuracy of online directories is a two-way street, and it is often difficult to get suppliers to report changes in their status in a timely manner, "said the spokesman of the Clare Krusing association.
Conclusion
for those who are enrolled in Medicare Advantage plans and plans health insurance exchange, find and keep doctors in the network has been a difficult undertaking. They were inaccurate and updated information for too long, making it difficult to get the medical attention they need. with the implementation of the new rules in 2016, the health care needs will be faster and easier to process.
We would like your opinion on the new rule for Medicare Advantage Plans and health insurance exchange. Please add your comments below!
0 Komentar