Is the New 2025 CMS Rule for Agent compensation actually GREAT news for AGENTS and FMOs?

[somarco]

MA carriers may or may not be better at policing fraud and with good reason. The fewer claims paid out leave more money for them.

Studies continually show that MA plans do NOT save money vs original Medicare.

This being said, DC has no incentive to find ways to cut costs. The way they spend money would embarrass a drunken sailor.

 

[rmhaire]

MA carriers may or may not be better at policing fraud and with good reason. The fewer claims paid out leave more money for them.

Studies continually show that MA plans do NOT save money vs original Medicare.

This being said, DC has no incentive to find ways to cut costs. The way they spend money would embarrass a drunken sailor.

The latest numbers show that MA costs a little over $300 more per beneficiary per year than OM does. Definitely the federales definition of saving money.

 

[somarco]

The latest numbers show that MA costs a little over $300 more per beneficiary per year than OM does. Definitely the federales definition of saving money.

MA providers are prone to upcode which is fraud.

MA carriers pay agent "bounties" for completing the HRA (health risk assessment) which are rarely, if ever verified and allows the carriers to receive capitation fees from CMS that are higher than the standard reimbursement.

Both upcoding and embellished HRA's have been investigated and, supposedly, are being addressed by Congress.

Not holding my breath, waiting on this to be corrected.

 

[Midlevel]

MA providers are prone to upcode which is fraud.

MA carriers pay agent "bounties" for completing the HRA (health risk assessment) which allows the carriers to receive capitation fees from CMS that are higher than the standard reimbursement.

Both upcoding and embellished HRA's have been investigated and, supposedly, are being addressed by Congress.

Not holding my breath, waiting on this to be corrected.

And Drs,, hospitals,skilled nursing, etc have never “upcoded” people on OM and a Med Sup. Laughable. Millions every day guaranteed and no one looks at it.

 

[rmhaire]

And Drs,, hospitals,skilled nursing, etc have never “upcoded” people on OM and a Med Sup. Laughable. Millions every day guaranteed and no one looks at it.

Figured you'd pop in.

 

[DonP]

And Drs,, hospitals,skilled nursing, etc have never “upcoded” people on OM and a Med Sup. Laughable. Millions every day guaranteed and no one looks at it.

It’s very simple why hospitals and drs love om and a sup vs mapd . Many many patients never pay the hospitals and clinics the copays with mapd . Many just don’t have the money . With om and a supp your getting your money

 

[Yagents]

Don't forget about the extra 1 to 2 employees on staff just to fight pre auths with mapds. That's a built in cost ignored.

 

[sman]

Lol my health insurance income went up over 100k by year 2 of obamCare thanks obama

Good for you. For the first two years it was ok, then carriers started pulling out and reducing commissions. In my county we had one carrier, the plan was total crap, and we got paid $10 per month to enroll someone. I wasn't about to work for $10 per month and field complaint calls all year long. Glad it worked out for you.

 

[DonP]

Don't forget about the extra 1 to 2 employees on staff just to fight pre auths with mapds. That's a built in cost ignored.

I know you’ve posted some on this . It seems the fmo’s interpret ( also any agent with a downline ) is exempt from the new law and will still get some form of overrides . I find it hard to believe this the case after more clarification from cms . So if this is true all they did is screw the agent ( supposedly no marketing money ,hra , enrollment software etc ) and leave all others alone . The $100 is a farce as agents were already making $70 for a hra so no net net gain there

 

[Midlevel]

Figured you'd pop in.

Even you knew how ridiculous it sounded.