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

[Jim Wright]

Yes over the coming months carriers will ask cms for guidance . Finality of rules will be known by July 1st model probably and how carriers interpret them

I agree here. I think carriers will take the lead and decide what they are going to police and what they are going to ignore. CMS certainly will not enforce this stuff.

 

[sman]

This is easily remedied with a note from the doctor and the physical therapist. A similar situation literally just happened about 2 months ago to a client of mine. They went to the first PA visit, gave it a try and said it hurt too much. They stopped. The PA informed the insurance company as well as the doctor. An appeal was filed, and it was immediately granted. This is what is always conveniently left out of the prior authorization arguments. How easily they’re remedied. The insurance company just wants to see that all logical steps are followed to rule out something as serious, and many times unnecessary, as a surgery. Surgery is a huge deal, and many times, doctors order these surgeries right away due to kickback deals they have in place.

If you say so. The doctor did get involved with an explanation. Carrier denied the appeal.

 

[Todd King]

Newby and Todd are not Fmo’s in the sense of size .They are imo’s For that matter neither is Brock or Brindle a fmo Fmo’s have 20-100 employees and do 300-100 k policys a yr . Fmo’s are Gordon Marketing , Nieshloss and Fleming , agent Pipeline . They contract 10-25 k agents .

So, what you're saying here is that you have a misunderstanding of what an IMO and an FMO is. Where did you get your definition? Who told you this? LOL

 

[rmhaire]

So, what you're saying here is that you have a misunderstanding of what an IMO and an FMO is. Where did you get your definition? Who told you this? LOL

Sorry you and @Newby can't be fmo's anymore. I never knew it was about size.

I wonder what's the cut off ..... I can always ask Lorena Bobbitt.

 

[Newby]

Newby and Todd are not Fmo’s in the sense of size .They are imo’s For that matter neither is Brock or Brindle a fmo Fmo’s have 20-100 employees and do 300-100 k policys a yr . Fmo’s are Gordon Marketing , Nieshloss and Fleming , agent Pipeline . They contract 10-25 k agents .

Sorry you and @Newby can't be fmo's anymore. I never knew it was about size.

I wonder what's the cut off ..... I can always ask Lorena Bobbitt.

I’m way past FMO. I’m a BFD.

 

[sshafran]

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.

The HRA is the last thing that should be verified.

I don't get paid extra if Mildred is sick.

Unlike her primary care doctor (who wants her to be), her specialist (who wants her to be), or her insurance carrier (who wants her to be - sorta) - I have no dog in the fight.

I doubt very much the most HRAs are embellished. Maybe some, but there is literally no incentive to embellish.

Maybe the questions are leading to embellish ailments? That's possible. Is that what you were referring to?

Which carrier HRAs are you referring to?

Having the agent do it is probably a good FWA deterrent. We have no incentive and we aren't pushing pills or denying claims...

 

[sshafran]

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

HRAs were not renewable.

 

[DonP]

So, what you're saying here is that you have a misunderstanding of what an IMO and an FMO is. Where did you get your definition? Who told you this? LOL

Ok fmo ,IMO whatever you call yourself . Let’s put it in blunt terms . Your very very small in premium and staff compared to
Gordon marketing,Neishloss and Fleming and on and on . Nothing wrong with that as you probably still make high 6 figs or 7 fig’s in overrides . I’m just stating facts .

 

[vic120]

Ok fmo ,IMO whatever you call yourself . Let’s put it in blunt terms . Your very very small in premium and staff compared to
Gordon marketing,Neishloss and Fleming and on and on . Nothing wrong with that as you probably still make high 6 figs or 7 fig’s in overrides . I’m just stating facts .

who is your fmo

as I understand integrity is not concerned about this

 

[rmhaire]

Ok fmo ,IMO whatever you call yourself . Let’s put it in blunt terms . Your very very small in premium and staff compared to
Gordon marketing,Neishloss and Fleming and on and on . Nothing wrong with that as you probably still make high 6 figs or 7 fig’s in overrides . I’m just stating facts .

Call him what you want. fmo, imo or idontknow. It doesn't matter. The main reason I use him and recommend him is:

His mother and my mother went to different schools together.