Paul Krugman on Medicare Advantage

Paul Krugman has written a column about Medicare Advantage, entitled First, Do Less Harm (accessed here via TruthOut, since Kugman's columns are behind the "paywall" at The New York Times Online).

[Once] Medicare ...started adjusting payments to reflect beneficiaries' health, the H.M.O.'s began dropping out: their extra layer of bureaucracy meant that they had higher costs than traditional Medicare and couldn't compete on a financially fair basis.

Regardless of how you feel about the political debate regarding Medicare payments, your Medicare Advantage plan must deal with the reality of risk-based payments in 2007.

3 "Can't Miss" Risk Adjustment Deadlines for 2007

With the new year upon us, it’s time to look ahead at CMS deadlines that will affect your Medicare Advantage plan during the coming year.

Your final opportunity to submit Risk Adjustment Payment System (RAPS) information regarding 2005 dates of service is January 31, 2007. This information will be used to correctly adjust payments made to your plan during 2006 based on the risk profile of your membership (75 percent of 2006 payments comes from 2005 risk adjustment data about your members). Don’t forget to make a final RAPS submission for 2005 dates of service before the end of the month, as it’s your last opportunity to do so.

You’ve already seen your 2007 payments in your MMR for January. These 100-percent-risk-adjusted payments were set based on dates of service between 7/1/2005 and 6/30/2006, so it's too late to fix them. The next payment adjustment will take place on 7/1/2007, based on dates of service from 1/1/2006 – 12/31/2006 and submitted by March 2, 2007.

Finally, your initial payment in 2008 will be determined by risk-adjustment information submitted by September 7, 2007. Being aware of these dates ensures your plan receives correct payment as soon as possible, rather than waiting for a final retrospective payment. More than ever, plan management requires a clear understanding of the cash flow implications of RAPS.

I want my NPI

In case it slipped your mind, May 23rd is the deadline for providers to begin using their 10-digit National Provider Identifier (NPI), as mandated by HIPAA back in 1996.

The idea is that instead of providers having a different identification number for every plan they interact with, providers would have a single number used by all plans (and Medicare):

The purpose of the National Provider Identifier (NPI) is to uniquely identify a health care provider in standard transactions... The compliance date for all covered entities except small health plans is May 23, 2007; the compliance date for small health plans [under $5 million in receipts] is May 23, 2008. As of the compliance dates, the NPI will be the only health care provider identifier that can be used for identification purposes in standard transactions by covered entities.

CMS has a very complete Web page on NPI along with lots of Q&A.

Do you know where each of your providers stands with regard to obtaining and using their NPI? There's only 137 days left until the deadline!

Happy New Year!

From all of us at Leprechaun, we wish you and your plan great success in 2007.