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Medicare Plan Election Period Begins Physicians are reminded that we are in the midst of the Medicare Advantage plan election period. The Centers for Medicare & Medicaid Services (CMS) has put increased emphasis this year on Medicare beneficiaries to confirm physician participation with the medical plans before enrollment. As a result, physician offices may experience an increase in phone calls and questions from seniors during this period. The enrollment period for Medicare Advantage plans runs from November 15 until December 31 each year. Plans selections made during this enrollment period are effective for the calendar year beginning January 1. Between November 15 and December 31, any Medicare-eligible person may enroll in a Humana Medicare Advantage plan or Medicare prescription drug plan (PDP). Existing Medicare Advantage or PDP members may elect to renew their current plan or select a new plan. Between January 1 and March 31 of each year, Medicare Advantage members are allowed to make one change to another plan if they choose. To better manage increased call volume during this time, it is suggested that physician offices put information about their Medicare Advantage plan participation on their automated phone greeting. Telephone receptionists and front office staff should also be prepared for requests for up-to-date information about the office's participation in various Medicare Advantage plans. Many enrollees and current members are expressing interest in Humana's Medicare Advantage PPO plans and Private Fee-for-Service plans. Participation in Humana Choice PPO and Humana Group Medicare PPO plans is possible as a contracted, in-network provider or noncontracted as an out-of-network provider. Physicians that are not currently contracted to participate in the Medicare Advantage PPO network are encouraged to take advantage of this opportunity. Participation in Humana Gold Choice or Humana Group Medicare PFFS is possible without a contract. Reimbursement is provided per Humana PFFS terms and conditions. For more information about Humana's Medicare Advantage PPO and PFFS plans:
Your local contracting and provider education representative can also provide information about sales seminars or other provider seminars in your area. Seminars are planned for most states. Physicians Reminded of Medicare Advantage (MA) enrollees are entitled to adequate notice of a decision to terminate Medicare coverage for services being received at a skilled nursing facility (SNF), home health agency (HHA) or comprehensive outpatient rehabilitation facility (CORF). The Centers for Medicare & Medicaid Services (CMS) has also ruled that MA-insured patients be informed of their right to an expedited review by a Quality Improvement Organization (QIO) if they disagree with their MA plans decision to terminate Medicare coverage. This CMS rule, commonly referred to as Fast Track Appeals or Grijalva rule, was implemented January 1, 2004. Under the Grijalva rule, the MA plan must provide notice through the provider (SNF, HHA or CORF) to enrollees of its decision to terminate services. The SNF, HHA or CORF is responsible for completing and delivering the Notice of Medicare Non-Coverage of Services (NOMNC) notice to enrollees. In these situations, it is important that primary care physicians, specialty care providers and Humana work together to coordinate discharge planning and patient notification. The Grijalva regulation also specifies the following delivery requirements for the NOMNC:
If the enrollee decides to appeal the decision, Humana assumes responsibility for responding to the appeal and providing the enrollee with future notices. The MA organization may require assistance from the provider in gathering detailed information needed to respond to the appeal. For more detailed information about Fast Track Appeals or the Grijalva rule, visit the CMS Web site at www.cms.hhs.gov/healthplans/appeals.
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