decisionhealth Newsletters, Part B News - 2013 Issue 5 (May)
Is sequester cut allowed on Medicare Advantage payments? Check your contract
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Article Overview
This article explains how Medicare Advantage payer reimbursement practices can be affected by sequestration-related reductions and why contract language matters. It is aimed at physicians, practice managers, and coding or reimbursement staff who review managed care contracts. The discussion covers CMS’s position, payer approaches, and common contract provisions that may affect whether a reduction can be applied.
Why This Topic Matters
The topic matters because managed care reimbursement can change based on contract wording and payer policy, affecting practice revenue and contract negotiations.
Article Sections
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Physician payments
Introduces the issue of Medicare Advantage payers applying reimbursement reductions and notes that payer policies may vary.
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Providers stuck with MA cuts in some cases
Summarizes differing expert views on when contract terms may allow or limit pass-through of reduced payments.
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The RBRVS case
Discusses contract language tied to Medicare methodology and broader questions about how reimbursement benchmarks are interpreted.
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3 contract details to watch for
Reviews general contract provisions and negotiation considerations that can affect reimbursement changes over time.
What You Will Learn
- How Medicare Advantage payment reductions may be handled in provider contracts
- Why contract wording can affect reimbursement outcomes
- What general types of contract provisions are commonly reviewed in this context
- How payer and provider perspectives can differ on reimbursement pass-throughs
Who Should Read This
- Physicians
- Practice managers
- Medical billing staff
- Coding and reimbursement professionals
- Contract negotiators
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