Medicare Advantage organizations are unresponsive to provider questions, long-term care professionals tell CMS

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Medicare Advantage organizations are unresponsive to provider questions, long-term professionals say
Medicare Advantage organizations are unresponsive to provider questions, long-term professionals say

Several skilled nursing facility workers expressed frustration regarding communications with Medicare Advantage organizations during a public call with government officials Wednesday. Centers for Medicare & Medicaid Services representatives acknowledged that provider frustration in this area has been an ongoing issue, but they said that their hands essentially are tied.

John Kane, a CMS skilled nursing facility program analyst, began the Open Door Forum call by stating that the agency has continued to receive provider questions regarding residents paying for nursing home care through Medicare Advantage. He reminded providers on the call that CMS is not able to address these questions, which must be directed to Medicare Advantage organizations directly. Under Medicare Advantage, health maintenance organizations or similar entities contract with the government to provide managed care services to beneficiaries enrolled in this system rather than traditional fee-for-service.

Despite Kane's statement, a number of callers posed Medicare Advantage-related questions. This also has occurred on other Open Door Forum calls in recent months. The officials on the call continued to direct callers to contact MAOs, and the providers emphasized that these organizations are not responsive.

“Questions are not being answered by MAOs,” one caller stated. He urged CMS to work with Medicare Advantage organizations to set up Open Door Forum-style calls, asking the officials on the call to “spur that along and give us an opportunity to conference with [MAOs].”

Kane responded that this was “a very good suggestion,” and he said providers' Medicare Advantage questions “are very good.” He said his directions to contact the MAOs were not meant to be “dismissive or pejorative,” but that he and his CMS colleagues are constrained by “the process we must follow.”

Also on the call, CMS confirmed that the next update to the MDS 3.0 RAI Manual will be released “on or about” Sept. 5.

Click here to access a recording of the call.

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