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Re: Medicare time!
Originally Posted by Steerpike
(Post 12755363)
I had the dubious honor of working for a company that was involved in doing 'risk adjustment' for MA plans. The penalties for falsifying / exaggerating the 'scores' are severe. But the great irony is - you don't have to falsify or exaggerate! All you have to do is accurately report the condition of a patient and the score increases. Why? Because the majority of people don't visit their doctor that often, and thus, their score remains stagnant based on their last visit. You said 'the risk score is only calculated once a year...' I think it's more accurate to say, it can only be adjusted 'at most' once a year, but if you don't visit the doctor the score cannot change. So what you do is - look at all the patients who haven't seen a doctor in at least a year, then figure out which ones are likely to have deteriorated over the past year, and then give them a free checkup. Patient gets a free checkup, score naturally increases because ... well ... they are getting older ... and reimbursement goes up. Everyone wins except the government ....
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Re: Medicare time!
I did not realise sick old people were so valuable. This explains why our Medicare Advantage plan provider keeps sending us detailed questionnaires on our health (I binned mine), invitations to "wellness visits", and has now got me wondering what my MA risk score is. I recently admitted to my doctor how much I drink, so that will have bumped up my score quite a bit. Now if I start smoking and put on a few more pounds, perhaps I can request a discount from my MA plan provider. And then I can bring my Mum over, get her RAF coded up, and auction her off to the highest MA plan provider bid.
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Re: Medicare time!
It is a ridulous time of year for those in the Medicare age bracket. In my mail today, there were seven pieces of mail that were Medicare related - three from United Healthcare, my Medicare Advantage provider, and four solicitations from other companies. Other companies want you to change to their plans, your provider deluges you with "Thank You" cards, magazines, proposals to send a nurse to your house for a "wellness visit," etc. etc. This goes on for nearly two moths, so that's hundreds of pieces of junk mail for the wood stove. The only important pieces arrived in the mail a couple of weeks ago. One is Medicare & You 2020, the official government Medicare handbook. It's 122 pages long this year. It basically lists all the hundreds of plans available to folks living in the various counties of New York State. The other is a letter from my provider, United Healthcare, listing changes to my current plan this year. I'll carry on with my present plan for next year, simply because it's the easiest option. I have no idea if it's any good, since I haven't been to the doctor for years. (I do get a free flu shot every year, but that'd be covered whatever Medicare I had.) |
Re: Medicare time!
Originally Posted by robin1234
(Post 12755871)
It is a ridulous time of year for those in the Medicare age bracket. In my mail today, there were seven pieces of mail that were Medicare related - three from United Healthcare, my Medicare Advantage provider, and four solicitations from other companies. Other companies want you to change to their plans, your provider deluges you with "Thank You" cards, magazines, proposals to send a nurse to your house for a "wellness visit," etc. etc. This goes on for nearly two moths, so that's hundreds of pieces of junk mail for the wood stove. The only important pieces arrived in the mail a couple of weeks ago. One is Medicare & You 2020, the official government Medicare handbook. It's 122 pages long this year. It basically lists all the hundreds of plans available to folks living in the various counties of New York State. The other is a letter from my provider, United Healthcare, listing changes to my current plan this year. I'll carry on with my present plan for next year, simply because it's the easiest option. I have no idea if it's any good, since I haven't been to the doctor for years. (I do get a free flu shot every year, but that'd be covered whatever Medicare I had.) |
Re: Medicare time!
Originally Posted by robin1234
(Post 12755871)
It is a ridulous time of year for those in the Medicare age bracket. In my mail today, there were seven pieces of mail that were Medicare related - three from United Healthcare, my Medicare Advantage provider, and four solicitations from other companies. Other companies want you to change to their plans, your provider deluges you with "Thank You" cards, magazines, proposals to send a nurse to your house for a "wellness visit," etc. etc. ... |
Re: Medicare time!
Originally Posted by Steerpike
(Post 12755976)
This could well be the visit that will get 'coded' and will update your risk adjusted score. When I was involved, it had to be a 'nurse practitioner', I believe (didn't have to be a doctor, but had to be more than a 'basic nurse' ... whatever that means!). I will say, in defense of that practice (small defense for a bigger problem), that a lot of genuine problems were found during these visits that would otherwise go undetected. More than once, our nurse practitioners ended up dispatching the patient to the hospital with life threatening conditions that the patient was ignoring.
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Re: Medicare time!
Originally Posted by ddsrph
(Post 12755902)
The above plus TV ads every 5 minutes. All out of the taxpayer’s pocket. This money spent on advertising could pay for a lot of healthcare. Then factor in all the different plans personnel costs and it really gets expensive. |
Re: Medicare time!
Originally Posted by robin1234
(Post 12756318)
Wow, that’s really interesting. Seems to indicate that it’s a common phenomenon to avoid going to the doctor - but to accede to the offer of an annual wellness visit to your home, by a nurse practitioner. I agreed to do it last year. (United Healthcare give you a $15 incentive for the visit.) She was in the house for an hour, and her journey time each way was over an hour ... so it seems to me her visit cost UH quite a bit. It was mostly “happy talk,†a questionnaire, and a fairly superficial examination, but certainly if I’d had some major problem brewing, she’d probably have spotted it. |
Re: Medicare time!
Originally Posted by Steerpike
(Post 12757446)
Did the NP identify herself as working for UHC or for a third party? Just curious ...
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Re: Medicare time!
Originally Posted by Rete
(Post 12754937)
We didn't find that to be true at all. Our Advantage Plan is Aetna Advantage and while it originates in New York State via the union, we use it down here in Mississippi without any problem. We pay for Medicare and separately for Aetna.
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Re: Medicare time!
Originally Posted by Nutmegger
(Post 12760238)
To revisit this Medicare thread, my HI agent has always recommended Medicare Supplement plans as opposed to Advantage plans, but I have just heard from him this week about a zero dollar premium Aetna plan that utilizes the Aetna National PPO network and combines medical, prescription, dental, vision, hearing. He says that there will be more exposure for deductibles and copays, but accounting for premium savings and one's individual situation, it may pay to make the switch. So I am currently reading up on the plan to see if it will work for me. But it is apparently something for Medicare users to look into.
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Re: Medicare time!
Dear Lord, after reading this thread I don't know how you all manage to negotiate healthcare there. I had a headache by the third post.
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Re: Medicare time!
Originally Posted by robin1234
(Post 12760282)
One thing to watch with switching from Medicare + Medicare Supplement to Medicare Advantage, is, if at some time in the future, you choose to switch back to M. supplement, will you be hit by a penalty on the premium for the supplement (as compared with the premium you would have been paying, had you stayed with the supplement plan.) |
Re: Medicare time!
Originally Posted by spouse of scouse
(Post 12760285)
Dear Lord, after reading this thread I don't know how you all manage to negotiate healthcare there. I had a headache by the third post.
Fortunately, they’re over-the-counter, not prescription.. |
Re: Medicare time!
Originally Posted by robin1234
(Post 12760282)
One thing to watch with switching from Medicare + Medicare Supplement to Medicare Advantage, is, if at some time in the future, you choose to switch back to M. supplement, will you be hit by a penalty on the premium for the supplement (as compared with the premium you would have been paying, had you stayed with the supplement plan.) |
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