Sellers of Medicare Advantage (MA) plans are now subject to tighter rules when it comes to marketing the insurance plans to seniors. CMS released a transmittal updating a 200-page section of its Medicare Managed Care Manual that's effective June 4, to reflect provisions in the health reform law. These rules come on top of stern measures CMS implemented in 2007 and 2008 that banned unsolicited telemarketing of MA plans and prohibited practices from letting MA marketers give presentations to patients.

Federal lawmakers return to Washington next week to take care of the Medicare payment fix and other provisions found in the American Jobs and Closing Tax Loopholes Act of 2010 (HR 4213). As you recall, the Senate left town for the Memorial Day holiday hours before the House voted for the bill.

There will likely be a fight or filibuster in the Senate over passing HR 4213. If you read Washington Post columnist Steven Pearlstein, the opposition should come from Senate Democrats. Pearlstein criticized conservative Democrats ("Blue Dogs") in the House this week for cutting $30 billion in health coverage and unemployment insurance from the tax bill, and choosing to keep $22 billion in funding to prevent Medicare reimbursements from falling off a cliff. Blue Dogs chose to pay physicians treating the elderly instead of providing money to those who can't afford insurance, he said.

Click to read more on doc fix

CMS has not only dropped the conversion factor it uses to calculate Medicare payments for this year, but the agency has altered the relative value units (RVUs) for thousands of codes used to pay for physician services.

Medicare billing expert Frank Cohen found 4,094 code groups had reductions in RVUs and 2,364 resulted in a net increases after CMS recently updated the Medicare Physician Fee Schedule database. We're still reviewing the updates, but the changes will have a negative impact for some physicians billing office visits. 

Example: The national payment rate for 99213 (office visit, established) had been $65.67 earlier this year, but will now pay $65.30. 99214 had paid $98.51, but now pays $97.77.

The Senate will not act on a Medicare payment fix before Memorial Day and allow the scheduled 21.2% sustainable growth rate (SGR) cut to go through.

Senate Majority Leader Harry Reid (D-Nev.) said this morning (May 28) they would wait for the House to act before considering the pay fix. The Senate is set to recess for the Memorial Day holiday and will return on June 7.

The temporary fix would replace the cut with a 2.2% increase retroactive to June 1. In 2011, reimbursement rates would increase by 1%. The House will vote on the measure sometime today.

Thanks to members of Congress, enforcement of the Red Flag Rules will not begin on June 1, 2010. In a May 28 press release, the Federal Trade Commission (FTC) announced it would delay enforcement until Dec. 31, 2010. But, enforcement could start sooner.

Congress requested another delay because it is still working on legislation that would limit the scope of the Red Flag Rules. On Oct. 20, 2009, the House of Representatives unanimously passed HR 3763, a bill that would automatically exempt some business from the Red Flag Rules and allow others to request an exemption. The Senate has taken no action on the bill since it went to the Senate's Committee on Banking, Housing, and Urban Affairs on Oct. 21, 2009.