RE:RE:RE:RE:RE:RE:RE:RE:RE:RE:RE:RE:Expanded RPM codes Medicare Advantage pays a fixed amount each month so the patient is on a budget. Is the patient really going to approve an increase in telehealth services ($50 to $315) when it eats into this fixed budget? Not bloody likely.
Rules for Medicare Advantage Plans
Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.
Each Medicare Advantage Plan can charge different
https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans/how-do-medicare-advantage-plans-work
Lifeboat1 wrote:
IFSCA - The point of my post which was the topic we were debating is whether MCOs have physicians on a capitation model or not for the programs that Reliq provides services for. Physicians are on a fee for service model as I said and is shown in the information that we both posted for RPM. MCOs are on a capitation model with CMS.
Going back to the point I think you were trying to make, which is not clear from your post, is that MCOs charge a co-pay. If you actually read it what they are talking in that section is about is Covid-19 related services which are not provided by Reliq.
I know from personal experience that MCOs don't charge a co-pay for RPM and CCM. There may be some that do, the US health system has lots of different payors but the point is there are plenty of patients out there on Medicare that do not have to pay co-pay. Even if some do it is not a major issue for this market IMO. Medicare includes well off people who can pay the $8-$60 per month to manage a potentially life threatening chronic illness and poorer people who don't have to pay. The segment that can't pay the co-pay and has to pay is a small piece of the pie in my analysis.