America's Benefit Specialist October 2022

MEDICARE MATTERS

tions about whether the bonus program includes too many measures, does not adequately account for social risk factors, and may not be a useful indicator of quality for beneficiaries. The full analyses are available on www. kff.org.

Senate to quickly take up this legislation and get it to President Biden’s desk.” The bill would establish an electronic prior-authorization process and require HHS to establish a process for “real-time decisions” for items and services that are routinely approved. It would also improve transparency by requiring MA plans to report to CMS on the extent of their use of 2015 and will reach at least $10 billion in 2022. Payments vary across firms, with UnitedHealthcare receiving the largest total payments ($2.8 billion) and Kaiser Permanente receiving the highest pay ment per enrollee ($521). Recently, the Medicare Payment Advisory Commission (MedPAC) and others have raised ques • Federal spending on MA bonus pay ments has increased every year since

On September 14, the House of Represen tatives unanimously passed legislation that would streamline the prior-authorization process used for Medicare Advantage patients. The Improving Seniors’ Timely Access to Care Act will move to the Senate for consideration. It already has strong bipartisan support there. The law proposes to make it easier for se nior patients to get care and improve health outcomes by modernizing the “antiquated” prior-authorization process, which often still requires using facsimile machines to send documents to insurance companies, said the announcement from sponsoring lawmakers. Nationally, about 28 million seniors use Medicare Advantage plans for their health insurance. The legislation was led by Representatives Suzan DelBene (D-WA), Mike Kelly (R-PA), Ami Bera (D-CA) and Larry Bucshon (R IN). It has more than 320 cosponsors. “Se niors and their families should be focused on getting the care they need, not faxing forms multiple times for procedures that are routinely approved. This takes away valuable time from providers who on average spend 13 hours a week on administrative paper work related to prior authorization,” the rep resentatives said in a joint statement. “The Improving Seniors’ Timely Access to Care Act will make it easier for seniors to get the care they need by cutting unnecessary red tape in the healthcare system. We urge the • Virtually all MA enrollees (99%) are in plans that require prior authorization for some services. Prior authorization is most often required for relatively expensive services, such as prescription drugs ad ministered by a physician (Part B drugs; 99%), skilled nursing facility stays (98%) and inpatient hospital stays (acute: 98%; psychiatric: 94%), but it is rarely required for preventive services (six percent).

HOUSE PASSES MA PRIOR-AUTHORIZATION REFORMS

prior authorization and the rate of approvals or denials. Finally, the bill would encourage plans to adopt prior-authorization programs that adhere to evidence-based medical guidelines in consultation with physicians. \The bill has bipartisan support in the Senate, where sponsor Senator Roger Mar shal (R-KS) called it “the most supported healthcare bill in the entire Congress.”

Integrity to Include Call-Recording Offering on Its MedicareCENTER Platform

Integrity Marketing Group recently announced the addition of call re cording to its proprietary MedicareCENTER software. The new solution will help agents comply with recently announced CMS regulations by offering them a simple and seamless way to record all sales calls, store the calls compliantly and download calls at any time, from anywhere. “Technology plays a crucial role in Integrity’s mission to help Ameri cans plan for the good days ahead,” said Harsh Singla, chief technology officer of Integrity. “We also know that technology needs to be easy to use to ultimately benefit the people it’s designed to help. That’s why we worked to make our MedicareCENTER Call Recording feature seamless and intuitive. It offers agents more than just a compliant way to record and store calls—it also gives them the abil-ity to automatically connect their calls to client contact records, which helps them manage their busi ness more effectively and efficiently.” To learn more about how MedicareCENTER call recording can help agents stay compliant and focused on serving Americans, watch this: www.medicarecenter.com/callrecording.

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