Medicare advantage vs traditional

[heybrother]

Hey. This message is being written from my phone so I apologize for the brevity.

This post is most relevant for private practice. There are variety of Medicare advantage plans in my area. One pays somewhere along the lines of 30-40+% less than traditional Medicare. I'm wondering if this is just a low paying plan or if perhaps somewhere along the way my office failed to negotiate or is doing something else wrong. Thoughts?

(Thanks in advance for feedback, commentary, ideas, jokes about private practice )

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[dtrack22]

I'm wondering if this is just a low paying plan or if perhaps somewhere along the way my office failed to negotiate or is doing something else wrong

is your office directly negotiating their contracts or are you part of an IPA? either way, Medicare advantage plans are bad, but the worst humana MA plan I’ve seen was still like 80% of Medicare. You can be sure that if you aren’t the only podiatrist in the area that you have zero chance of negotiating that up (and the practice may have tried). There is a DPM desperate enough to take than in any decent sized city...

 

[G0dFather]

some are good and some are bad ( but never that bad from what ive seen) ... Aetna MA plan is great for example at least in my area ... MA will keep increasing going forward

 

[heybrother]

Appreciate the feedback. We are definitely talking Humana. My partners are the types who would say everything is bad but wouldn't actually know what anything pays or what was signed or agreed to. I am definitely the first person to say what is going on. Having this conversation is dragging up a recollection of a story I didn't understand at all he time about another new doc fighting for Medicare rates and it must have been advantage plans. I've got feelers out to another guy in town who was surprised when I told him. As you said though, can anything actually be done. Probably not.

 

[dtrack22]

Having this conversation is dragging up a recollection of a story I didn't understand at all he time about another new doc fighting for Medicare rates and it must have been advantage plans.

probably, but not necessarily. I’ve had colleagues who have been offered 90% of Medicare rates by major commercial plans (ie BCBS).

something can be done, but the podiatrists in the area would all have to agree not to take these ****ty plans. They may come up from a rate standpoint if they don’t have any providers in network...

 

[Creflo]

I will do everything in my power to not take these plans. Medicare already pays too low, and to accept even lower from advantage plans does not compensate adequately. I'm not going to see 50 patients per day, providing substandard care as a result, in order to pay the bills. I accept original medicare only, and for all advantage plans I charge cash and give the patient an invoice to self file. I have had several patients learn the hard way that the advantage plans are actually a disadvantage, then they go back to original medicare. The advantage plans spend tons of money on TV commercials and other advertising, on deceptive "fairs" and "parties" in low income housing facilities, and they spend money sending salespeople out to sign patients up while making promises of all of the "advantages" of extra care when the reality is they get less care, and have more hoops to jump through to get care.

 

[king22]

I'm in a suburb of NYC and pretty much all Advantage plans stink when it comes to reimbursement rates (unless you're in an IPA). BCBS MA pays about 60% of Medicare rates for visits, about 80% for procedures (with the exception of routine care which pays at about 60%), UHC MA pays about 75%. I'm in an IPA which thankfully brought my UHC MA rates up to 100% of Medicare for current year fee schedule and BCBS up to 100% of 2015 Medicare rates. The worst however, by far, Is Aetna MA. Besides the same crappy rates for visits (it's about 60%), routine foot care reimburses at 50% medicare rates. And that's not all, over the past year Aetna started halving all procedure fees if the service is performed in any type of outpatient facility (other than an office), or in a patient's home. I billed a 11721 with a 11056 and got paid $8 and $21 respectively for a patient at my assisted living facility. One patient with an ulcer that I did a 11042 on paid $49.50.

Every IPA i talk to that has Aetna contracts says that Aetna refuses to budge on their MA fee schedule.

 

[king22]

It gets even better being in NY. NY Medicaid doesn't pay the 20% or any copay amount when acting as a secondary. For this new year, I've had at least a half dozen of my patients who had medicaid as a secondary transfer into an Aetna MA plan. There co-pay is $45 a visit so If i decide to see them, I'm already down $45. So If i end up billing a 99213, I'd end up with $12.

 

[king22]

some are good and some are bad ( but never that bad from what ive seen) ... Aetna MA plan is great for example at least in my area ... MA will keep increasing going forward

It says you are from NY, what part? If you read my above comments, you will see that Aetna stinks in my part of the state (Long Island)

 

[G0dFather]

It says you are from NY, what part? If you read my above comments, you will see that Aetna stinks in my part of the state (Long Island)

Practices in the city and LI .... Atena Medicare PPO pays 100% of medicare rates ... i dont know what your referring to in the above post

 

[king22]

Practices in the city and LI .... Atena Medicare PPO pays 100% of medicare rates ... i dont know what your referring to in the above post

I'm referring to All Aetna Medicare Advantage plans that I see (which primarily are the PPOs). At the moment, all Aetna plans, commercial and Medicare advantage (with the exception of Medicaid plans) pay at the exact same rate. That will change for me starting Feb when my IPA rates kick in (IPA rates are significantly higher than my current rates but the enhanced rates only apply to commercial plans).

My offices are in Suffolk County.

 

[G0dFather]

I'm referring to All Aetna Medicare Advantage plans that I see (which primarily are the PPOs). At the moment, all Aetna plans, commercial and Medicare advantage (with the exception of Medicaid plans) pay at the exact same rate. That will change for me starting Feb when my IPA rates kick in (IPA rates are significantly higher than my current rates but the enhanced rates only apply to commercial plans).

My offices are in Suffolk County.

Nice .. Sufflok county is a gold mine .. go out on your own if you havent already ... also living high end in that region is much more affordable than the city or nassau