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Andreas93
2 months ago
4

Able, Baker, and Charles are engaged in the marketing to and enrollment of beneficiaries into Medicare health plans. Mr. Able is

an independent agent paid directly by a health plan. Ms. Baker is an independent agent paid through a field marketing organization (FMO). Mr. Charles is an independent agent paid for his work by a third-party marketing organization (TMO). How do the CMS compensation rules apply to these three agents?
Business
2 answers:
Katen [3.5K]2 months ago
7 0

Las normas de compensación del CMS establecen que la remuneración pagada en el primer año debe ser superior a la de los años siguientes. Además, la compensación para los años de renovación no puede ser menor al 50% de la del año inicial.

Más detalles:

CMS: El Centro para Medicare & Medicaid Services, parte del Departamento de Salud y Servicios Humanos de EE.UU., regula varios programas relacionados con tecnología sanitaria, incluyendo la gestión de registros electrónicos de salud (EHR). También supervisa costos médicos y administra el Programa de Seguro de Salud Infantil (CHIP).

Las compañías que ofrecen servicios de salud emplean agentes o corredores para vender planes Medicare a beneficiarios. Los corredores reciben pago mayor durante el primer año de la póliza y luego reciben al menos la mitad de ese monto en los años siguientes si continúan inscritos. Los agentes deben tener licencia estatal y completar capacitación anual, además de aprobar un examen sobre Medicare y planes de medicamentos para la salud.

Normas de compensación CMS:

Sr. Able:

  • La compensación inicial no puede superar el doble de la pagada en los años de renovación durante un ciclo de seis años.
  • El pago del primer año debe ser mayor que el de renovación.
  • La compensación renovada no debe ser menor al 50% del pago inicial y debe reflejar el valor justo de mercado por el trabajo realizado.

Sr. Baker:

  • Se aplican las mismas reglas que para Able respecto a límites y proporciones de compensación.
  • Las organizaciones que contratan con FMOs o entidades similares deben pagar basándose en el valor justo de mercado, sin exceder los montos pagados por servicios similares en los dos años anteriores.

Sr. Charles:

  • Aplica el mismo criterio de compensación inicial y renovación que los anteriores.
  • También se aplica la regla sobre pagos basados en valor justo de mercado para contratos con FMOs o entidades similares.
  • La estructura de pagos debe ser reportada por la organización de marketing tercerizada (TMO).
harina [3.8K]2 months ago
4 0

Respuesta:

a. Able está sujeto a las normas de compensación CMS porque recibe pago directo de un plan de salud. Por otro lado, Baker y Charles no están sujetos a estas reglas, ya que su remuneración proviene de terceros.

Justificación:

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