MA plans pros and cons

What the pros and cons of contracting with the MA plans?
Are most providers going to contract or not? If not, are you going to see them out of network??

Evil!

There is no "contracting" - if you see a MA patient, you are contracted for that one patient. You can elect to see these patients or not, even on a visit to visit basis. If you see one, your are not obligated to take any more or you can pick and choose.

But on the other hand, we have huge problems getting paid; they also are constantly asking for copies of records (at our cost); you have to go thru their precertification process for xrays, surgeries, etc and you get paid the same as traditional Medicare. We avoid the plans and in fact just kicked out every patient (many were with me for 10+ years) that has Today's Options since they seemed to be the worst and paid no bills at all.

MA plans pros and cons

For 2010, contracts are required for some plans (non-PFFS). In 2011, contracts are required for all MA plans.

I agree...

Today's Options is HORRIBLE. One of our elderly patients even had to hire a lawyer to fight back against Today's Options. They had retroactively canceled her policy even though all the premiums were paid.

Also, Aetna Medicare doesn't always follow traditional Medicare's rates. They still pay us at Medicare rates from a few years back, which is less than Medicare pays today. Phone calls, appeals, action with provider service was no help.

One more comment about MA plans is that if you have a patient with Medicaid secondary to traditional Medicare then Medicaid would pay the entire 20% and any deductibles applied by Medicare. But since MA plans are considered "commercial", Medicaid doesn't have to follow the same rules and won't pay anything above what Medicaid would pay had they been the primary insurance. So I have to write off nearly every coinsurance/copayment from Medicare Advantage patients with Medicaid secondary.

None of us like them but the patients do

The other problem is that the patient doesn't tell you they are signed up with a MA plan. they give you their normal Medicare card (which they still have) and then you bill fee for service Medicare and then you find out they have a Medicare Advantage plan.

Look at the rates really carefully, and the market share. If they have a small market share, don't sign up.

Some of the bigger payers have a piece in their commercial contracts that seems to require you to participate in all of their products, including Medicare Advantage. Try not to sign that.