Medicare Advantage Plan Update

AAFP Calls for CCM Coverage, Solid Networks, Standardized Directories

March 09, 2015 02:53 pm News Staff

The AAFP recently intervened on behalf of family physicians and their patients covered by Medicare Advantage health plans by asking CMS to ensure that the new chronic care management code is recognized and that provider directories are standardized.

[Vintage typewriter with the word

In a March 5 letter(3 page PDF) to CMS Deputy Administrator Sean Cavanaugh, AAFP Board Chair Reid Blackwelder, M.D., of Kingsport, Tenn., reminded CMS that on Jan. 1, traditional Medicare Part B began paying physicians for chronic care management services. He expressed surprise that CMS couldn't say at a recent educational session that Medicare Advantage plans had to recognize the code.

"During the call, the question was asked whether Medicare Advantage plans were required to recognize the CCM," said Blackwelder, and CMS responded that the question needed to be "vetted further" by CMS Medicare Advantage staff.

"The AAFP urges CMS to specify that all Medicare Advantage plans recognize and provide reimbursement for the CCM," said Blackwelder. "Elderly and disabled patients (who) receive coverage through Medicare Advantage plans should have equal access to benefits available to beneficiaries receiving health insurance coverage through traditional Medicare."

Network Adequacy

Blackwelder said that valid provider directories were critical to addressing accessibility issues for Medicare Advantage beneficiaries.

Story Highlights
  • AAFP Board Chair Reid Blackwelder, M.D., recently asked CMS in a letter to ensure that Medicare Advantage plans recognize the new chronic care management code.
  • The AAFP also offered recommendations regarding adequate provider networks and standardized and easy-to-use provider directories.
  • Directories should be quickly updated whenever physicians stop or resume accepting new patients, the AAFP said.

"Without these directories, beneficiaries face unfair, costly and protracted obstacles to receive the care, treatment and follow-up they need," said Blackwelder. "In the case of family medicine and primary care, accurate and up-to-date physician directories ensure health care's main entry point stays open and easily accessible to seniors."

Blackwelder urged CMS to make Medicare Advantage organizations responsible for keeping directories current and for ensuring that IT infrastructure used to create directories "does not create an additional overly burdensome reporting requirement for providers."

Blackwelder suggested that updated physician information be relayed electronically with an embedded hyperlink to automatically update the insurance plan's online provider directory.

Provider Directories

Due to the large number of Medicare Advantage organizations, Blackwelder urged CMS to require standardization of provider directories so the only information collected and updated would be the provider's name, practice location, phone number, website, office hours and other information regarding provider availability.

Furthermore, any Web page where physicians change or update their information should be prepopulated with the insurance products and networks with whom the physician currently participates, said Blackwelder. Overall, he added, CMS should push Medicare Advantage plans to create physician interface Web pages that were intuitive and easily navigated.

One important piece of information that could fluctuate throughout a calendar year would be a physician's willingness to accept new patients.

"Therefore, the MAO's (Medicare Advantage organization) website for physicians should have a check-box feature that is easily accessible for them to check," Blackwelder said.

"That crucial piece of information must be updated onto the MAO's online provider directory instantly," said Blackwelder. And, with automatic electronic updates to provider directories, quarterly communications between MAOs and physicians should suffice, he added.

"If CMS moves forward with creating a nationwide provider database, the AAFP would like to reiterate its position that physicians have a key part, but MAOs should provide the bulk of the information," said Blackwelder. "The network information should be aggregated directly from the MAO's accurate and up-to-date provider directories. Physicians should not be expected to go to another website to update the nationwide provider database," he added.

Related AAFP News Coverage
Letter to CMS
Guard Against Narrow Networks in Medicare Advantage Plans, Says AAFP


Safeguard Provider Network Adequacy, AAFP Tells CMS
Academy Tackles Narrow Networks Issue at Federal, State Levels