September 2014
September 2014: Volume 1, Number 5
Despite Physician Terminations, Medicare Advantage Contracts See an Increase in CMS’ Star Rating System
On September 18, the Centers for Medicare and Medicaid Services (CMS) announced that approximately 40% of Medicare Advantage contracts will receive four or more stars for 2015, an increase of around 6% from 2014. The announcement is against a backdrop of narrowing networks and midyear, no-cause provider termination notices. For example, in 2013, United Healthcare terminated approximately 2200 Connecticut physicians as participating physicians in United’s Medicare Advantage program.
** This article includes links to forms for you and your patients to report you being terminated from a Medicare advantage program. **
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ASRS Launches Updated Compounding Pharmacy Questionnaire to Assist Members in Evaluating Compounders
Building on the ASRS 2012 efforts to gather essential quality assurance information from compounding pharmacies to assist members in selecting a compounding pharmacy, ASRS is now joining forces with the American Academy of Ophthalmology (AAO) to ask compounding pharmacies to complete an updated questionnaire. The new questionnaire differentiates between traditional compounders and the new FDA-regulated 503B outsourcing facilities created by the Drug Quality and Security Act.
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Drastic Fee Schedule Reductions by Private Insurers May Impact DME Patient Treatment
ASRS members recently reported that several health Insurance companies (eg, Blue Cross/Blue Shield and Aetna) have changed without notice their commercial product fee schedules for Lucentis and Eylea from ASP-Plus-4% to ASP or lower. Patients buying top line insurance may be shocked to learn that despite high premiums, policies are being implemented which are intended to limit access to FDA-approved drugs for Diabetic Macular Edema and Age-Related Macular Degeneration.
Open Payments Data Will Be Released on September 30. Are You Prepared for Patient and Media Questions?
On September 30, the Centers for Medicare & Medicaid Services (CMS) will release to the public all financial interactions between physicians and industry as part of Open Payments (The Sunshine Act). CMS gave physicians until September 10 to register, review, and dispute any data attributed to them under the Open Payments system and to request their individual reports for review or dispute.
The intention of Open Payments reports is to provide the public—your patients—with information on financial interactions between physicians and industry. As a physician, it is important to prepare yourself to receive questions from your patients or the media once this information is made public.
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I Received a Request for Records. What Do I Do Now?
All payers conduct audits. The way audits are conducted, it is inevitable that at some time during your career you will receive a request for records. The questions are: how prepared are you when that request comes, and do you have proper protocol in place?
