I do not usually report on what other media are reporting (with the exception of Nina Youngstrom’s reports on Medicare compliance!), but John Oliver’s story about Medicare Advantage (MA) plans merits mention.
On Sunday, Oct. 26, John did about a 20-minute segment discussing the fact that MA plans come with narrowed networks and pre-authorization. I thought the segment was quite well done.
As we are in the midst of open enrollment right now, it can be useful to have patients recognize that while MA plans can offer coverage not found in traditional Medicare, there are very material downsides that come with it. I have often wanted to take a poll of people who work in the healthcare industry to see whether they would sign up for a MA plan.
Personally, I would not.
If my doctor and I think a service is medically appropriate, I do not want to have to deal with prior authorization. I also would like to have as broad a network of professionals to choose from as possible. The bottom line is that personally, I would choose traditional Medicare. If you are part of one of the many healthcare organizations that is struggling with your MA reimbursement contracts, you may want to encourage patients to watch John Oliver’s segment. It wouldn’t be crazy to have a link on your home page.
Now, for something completely different. Last week, the federal government issued a new interpretive rule intended to prevent states from prohibiting healthcare organizations from reporting debt to credit agencies. That is a confusing sentence with a double negative, so let me try to explain.
A number of states have decided that it is unfair for a person’s credit rating to be harmed by the fact that they have medical debt. Those states have passed laws that prevent healthcare organizations from reporting medical debt to credit bureaus.
Last week, the Consumer Financial Protection Bureau issued an interpretive rule asserting that the Fair Credit Reporting Act (FCRA) preempts state laws that touch on broad areas like credit reporting. The interpretive rule focuses on statutory language that says no requirement or prohibition may be imposed under the laws of any state with respect to any subject matter regulated under FCRA.
One interesting thing about the issuance was how a government agency is stating that government agencies lack power. While the President is routinely asserting arguments that there is essentially unlimited executive power, here, a federal agency, part of the Executive Branch, is saying federal agencies have greatly restricted power and they are bound by Congress’s decision to preempt state laws.
Whichever side of the strong executive you fall on, the inconsistency is readily apparent. But the bottom line is that the federal government asserts that states lack the authority to prohibit reports to credit agencies.
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Clinical documentation integrity (CDI) professionals work in a variety of settings, and although I mostly focus on topics related to hospital inpatient billing, this week
With so much focus within the federal government on abuse, fraud, and waste, I thought it might be helpful to review a couple of federal
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