2011 Provider Manual - Universal American Medicare
2011 Provider Manual - Universal American Medicare
2011 Provider Manual - Universal American Medicare
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
Chapter B: Physician Standards and Procedures<br />
<strong>Medicare</strong> Improvements for Patients and <strong>Provider</strong>s Act (MIPPA)<br />
<strong>Medicare</strong> Improvements for Patients<br />
and <strong>Provider</strong>s Act (MIPPA)<br />
General Rules<br />
Effective Jan. 1, 2009, the <strong>Medicare</strong> Improvements for Patients and <strong>Provider</strong>s Act<br />
(MIPPA) imposed prohibitions on certain sales and marketing activities under<br />
<strong>Medicare</strong> Advantage (MA) and <strong>Medicare</strong> Advantage-Prescription Drug (MA-PD)<br />
plans. Such activities include door-to-door sales, cold calling, free meals and crossselling<br />
of non health-related products.<br />
In general:<br />
• Doctors and office staff may not encourage patients to join the plan in any way;<br />
doing so is considered “steering”<br />
• The Centers for <strong>Medicare</strong> & Medicaid Services (CMS) draws no distinction<br />
between exclusive and non-exclusive groups when it comes to regulations on<br />
steering<br />
• <strong>Provider</strong>s must make available to their patients information for all plans with<br />
which they are affiliated, including common area availability for health plan<br />
events, health plan posters and marketing materials, and any other proposed<br />
materials<br />
Plan Affiliations<br />
<strong>Provider</strong>s should:<br />
• Release the names of plans with which they are affiliated<br />
• Announce plan affiliations through general advertising; however, new affiliation<br />
announcements that name only one plan may occur only once when using direct<br />
mail and/or e-mail. Additional communications must include all plans with<br />
which the provider contracts.<br />
• Display affiliation banners, brochures and/or posters for all plans that have<br />
provided such materials and with which the provider is affiliated<br />
• Get approval from CMS for any affiliation communication materials that describe<br />
plans in any way (e.g. benefits or formularies)<br />
<strong>Provider</strong> <strong>Manual</strong> B.30 Generations Healthcare<br />
Published July <strong>2011</strong><br />
© <strong>2011</strong>. All rights reserved.
Change language