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Medicare Part C - What You Don't Know Can Cost You Plenty

Medicare Part C - What You Don't Know Can Cost You Plenty


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Speakers: Karen Zupko and Pat Hofstra

Medicare Part A, B and D are well known to almost everyone in a practice - part C however is largely not well known. Many administrators think Part C is only Medicare HMOs and PPOs and because they've chosen not to contract with these plans, they mistakenly think, " "Over and done." " Medicare Advantage Plans have made a lot of headlines recently. They've drawn attention both for their overly aggressive marketing tactics and as a sticking point in the recent congressional battle to block the 10.6% cut in Medicare reimbursement rates. What neither of these stories mention,
however, are the effect these privatized plans have on physician practices.

The experts at Karen Zupko & Associates have found that many practice's Medicare Advantage Plans contain a variety of unknown factors. For example, numerous physicians and managers believe that Advantage Plans exclusively refer to HMO and PPO plans which they can make a conscious choice about contracting. They have found that many managers and physicians are unaware of the Medicare Advantage Private Fee-for-Service (PFFS) plans created under Part C and the complications they may entail.

Medicare Private for Fee for Service (PFFS) plans also included in Part C are the unseen problem in many practices because there is NO contract to sign. You simply see a patient until you are " "deemed in." "

The substantial growth of these enrollees means your practices must pay attention and get smart NOW.

Some statistics:

1. Enrollment in PFFS plans jumped from roughly 850, 000 in December 2006 to nearly 1.6 million in June of the following year.

2. Currently, about 26% of PFFS enrollees are in employer- sponsored plans, but this number is projected to rapidly expand due to the lower cost for employers.

3. In Dec. 2005, 18% of rural MA enrollees were in PFFS plans.today, that number is 62% (only 16% for urban beneficiaries).

4. A plans get paid on average 13% more per patient (about 17% for PFFS plan holders) than traditional Medicare would spend if it were covering those patients directly. This creates a $16
billion a year subsidy for the healthcare industry.

5. A recent AMA survey found that more than 50% of physicians reported receiving payments below the traditional Medicare rate.

Joining Karen is Duane Morris Health care attorney Pat Hofstra to provide the legal insights about Part C plans and what your contracting strategy options are.

Meet Our Expert Speakers:

Karen A. Zupko is the President of Karen Zupko & Associates, based in Chicago. Before Wall Street discovered practice management, Karen Zupko was actively involved in developing the field through educational programs, writing and consulting. Her 25 years in the field demonstrates her belief in and her commitment to physicians. Prior to opening her firm, Ms. Zupko headed the American Medical Association's Department of Practice Management. Beginning solo in 1985, she has built the firm to 21 staff members with specific skills in management, reimbursement, marketing, and managed care contracting. Clients include physician practices, MSO's, academic medical centers, Fortune 500 pharmaceutical companies, hospitals and medical associations.

Patricia S. Hofstra is a Partner in the Duane Morris, LLP office in Chicago. She practices in the area of health law and she advises healthcare professionals and healthcare companies in corporate, regulatory and litigation matters. Pat's clients include hospitals, long-term care providers, physicians and physician practice groups, retail clinics, home health agencies, ambulatory care centers, medical device manufacturers, pharmaceutical companies and other healthcare companies. She has
extensive experience in business transactions involving healthcare entities, medical staff matters, licensure and regulatory matters, managed care contracting, hospital/physician contracting, joint ventures and information technology. She regularly advises clients on fraud and abuse, governance, Stark and intermediate sanction issues.