The house well being business’s battle with Medicare Benefit (MA) plans for honest charges has gone from a couple of stakeholders saying “the quiet half out loud” earlier this yr to just about each main supplier within the nation speaking concerning the subject with regularity.
My colleagues and I’ve coated the subject extensively. However we’ve moved past the query of how suppliers really feel about MA charges for residence well being and moved onto the following: How can the issue be solved?
Taking a step again, listed here are a couple of of the certainties we all know:
– All indicators level to MA being the dominant insurer kind amongst Medicare beneficiaries by the tip of the last decade.
– MA pays far decrease charges for residence well being providers in comparison with charge for service (FFS). Embody Well being Company (NYSE: EHC) stated this week that MA charges are at a 40% “low cost” in comparison with FFS. Intrepid USA Healthcare Providers confirmed that quantity was about in step with its expertise – and even advised the charges have been typically decrease than that.
– Two corporations with vital market share in MA – Humana Inc. (NYSE: HUM) and UnitedHealth Group (NYSE: UNH) – have already – or are within the technique of – buying two of the most important residence well being suppliers within the nation in Kindred at Residence and LHC Group Inc. (Nasdaq: LHCG), respectively.
– Some have described MA because the federal authorities’s “darling.” However the Workplace of Inspector Common (OIG) not too long ago revealed a report condemning MA organizations for limiting beneficiaries’ entry to vital care and denying funds to suppliers for providers which are coated below Medicare and MA billing guidelines.
“It’s been a problem as a result of, not solely is the speed decrease, however the processing of the claims is 6 to eight instances tougher in your again workplace income cycle,” Intrepid USA CEO John Kunysz instructed me. “They only put in so many hurdles.”
Primarily based in Texas, Intrepid USA suppliers residence well being and hospice providers, with over 60 areas spanning throughout 17 states.
On this week’s unique, members-only HHCN+ Replace, I discover the tumultuous relationship between the house well being business and MA, and in addition attempt to spotlight some potential options for the street forward.
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