CMS Proposes Rule to Rein in Medicare Advantage Plans

AAFP, 80-Plus Medical Organizations Applaud CMS Efforts

January 12, 2010 05:15 pm News Staff

Physicians concerned about time-consuming policies and directives dispensed by Medicare Advantage organizations -- health plan options for beneficiaries that are included in the Medicare program -- should be aware of a CMS proposed rule that aims to provide some relief.

The rule(, which was published late in 2009, proposes revisions to the advantage plan program and to the prescription drug benefit program.

In response to the proposed rule, the AAFP, AMA and more than 80 other professional medical organizations commend the agency for its suggested changes in a joint comment letter( to CMS Acting Administrator Charlene Frizzera.

In the December letter, the medical organizations say they agree with language in the proposed rule that says Medicare Advantage plans shouldn't force physicians to duplicate Medicare enrollment requirements. "Requiring an additional fraud, waste and abuse certification imposes an additional unnecessary burden on physicians," says the letter.

The organizations also agree with CMS that it is unfair of Medicare Advantage plans to require that their network physicians take education courses in fraud, waste and abuse compliance. "The result is that the same education requirement, which has already been met by every physician who has a Medicare provider number, is being duplicated many times over," says the letter. The organizations view the requirement as "substantially increasing the hassle factor" for physicians whose patients are enrolled in Medicare Advantage plans.

In addition, the letter commends CMS for seeking to increase its oversight of the plans and points out that physicians have reported "extremely burdensome audits" of their patients' charts. Advantage plans that initiate audits rarely reimburse practices for the resources required to pull, photocopy and refile patient charts, says the letter.

The letter also speaks on behalf of Medicare beneficiaries when it says that patients find the rapid proliferation of Medicare prescription drug and advantage plans "bewildering." The medical organizations support CMS' proposals calling for

  • advantage plan choices that differ enough to provide beneficiaries "meaningful options," and
  • standardized templates -- such as evidence of coverage notices -- in beneficiary communication materials.

"Physicians and their staff (members) are often on the front lines of deciphering these changes and explaining them to their Medicare patients," says the letter.

CMS will review all comments and issue a final rule later this year.

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