At this week's Annual Leadership Conference of the Home Care Association of America, the usual lineup of keynote addresses and breakout sessions filled a packed, two-day schedule, followed by an assault on Capitol Hill on day three. What conference organizers will remember most is that they did not schedule a classroom large enough for a breakout titled, "The New Medicare Advantage Benefits: What it Could Mean for your Agency."
Do not blame the organizers. The hotel probably did not have a room big enough.
Consultants Anne Tomlinson and Ginny Kenyon gave the overflow crowd of Private Duty Home Care executives a thorough background and history of the federal Medicare Advantage program and followed with detail about what they can expect over the next two years. Though their briefing was based on what limited information CMS has released so far, it gave the audience some valuable marching orders.
A provision in the Bipartisan Budget Act of 2018 opened the door for insurers who participate in Medicare Advantage to cover certain non-medical services for their members. Approximately one-third of Medicare beneficiaries have opted for Medicare Advantage over straight Medicare or Medicare with a commercial supplement so far.
Final rules will be published in December but only minor changes are expected for calendar year 2019 with full implementation to arrive in 2020. According to Ginny Kenyon:
While most non-medical providers cannot wait for the MA doors to open next year, there are a few observers and agency owners approaching the new rule with caution. We spoke with Bob Roth, founder and Managing Partner of Cypress Home Care in Phoenix. "I'm feeling positive about offering these services to our clients and patients who are enrolled in Medicare Advantage," he told us, "but I'm waiting to see what hoops CMS might be requiring us to jump through. What certifications will they want? What kinds of claims? Will our software have to undergo major changes?"
Roth's concerns were echoed by the software vendors we spoke with at the HCAOA conference. Friendly competitors Geoff Nudd, CEO of ClearCare, and Todd Allen, CEO of AxisCare, said they are ready to begin to work on adding MA claims capability to their products but cannot begin until specific guidance is released by CMS. Even after that guidance appears, however, these MA plans are still private insurance companies that can create their own forms and set their own claims procedures. There is no requirement on the horizon that will demand uniformity among them.
That concern led us to another HCAOA exhibitor that might be effective in the middle, between providers and MA plans. Paradigm Claim Services takes over the tedious paperwork for home care agencies, often acting as their entire billing department. Chief Customer Officer John Corrigan told us about one of the advantages of using his service. "In addition to reducing denials by making sure claims are clean and accurate before being submitted, we have gained some clout with payers," Corrigan said. "We convinced their legal teams to allow us to submit claims on our forms instead of having to adapt to every insurer's unique form. They wouldn't do that for any one individual provider. And we think we will be able to get the same concession from MA plans when the time comes."
CMS has concerns as well, Ann Tomlinson told the gathering. When the Act was signed into law, regulators queried Congress about limited Medicare dollars being diverted to cover increased spending by MA plans. This arises, she explained, from the way MA plans are funded. "Each plan bids for business, every year, based on a benchmark monthly premium specific to each county. But those benchmarks are then risk-adjusted. So they may only be paid 70 percent of the benchmark for their healthy 65-year old members but as much as 2.8 times the benchmark for an 89-year old with several co-morbidities."
Questions from the packed room revealed provider concerns as well. "How do we figure out who is eligible?" "How much benefit should we provide?" "How do we describe and market our less familiar services, such as adult day care?"
The two consultants did offer some recommendations to home care providers, keeping in mind that MA plans care first about their enrollment numbers and only secondarily about actual healthcare spending.
©2018 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. email@example.com