Elevance Health is changing how it evaluates and pays certain hospital claims, putting greater scrutiny on where care is delivered as the insurer moves to address higher hospital rates for services provided at off-campus locations.
A common practice for Medicare, Elevance Health said it was the first commercial market payer to...
The Centers for Medicare & Medicaid Services (CMS) on Monday finalized a stronger-than-expected payment update for Medicare Advantage (MA) plans in 2027, backing off from an earlier proposal from the agency that signaled flat funding, which triggered industry concern over benefit cuts and market exits.
CMS said the final rate...
On Wednesday, the Centers for Medicare and Medicaid Services (CMS) proposed an overall increase to MA plans of 3.7%, a $16 billion bump over 2024. At the start of each new year, MA stakeholders wait for CMS to propose next year's MA capitation rates and Part C & D payment policies. After what is expected to be a vigorous comment...
Last Wednesday, the Medicare Payment Advisory Commission (MedPAC) published its biennial report to Congress which included recommendations to streamline alternative payment models (APMs) within the Medicare program. It also recommended a strategy to improve accuracy in Medicare Advantage (MA) payments and correct a major contributor to...
Last week the Centers for Medicare & Medicaid Services proposed to phase in a new risk adjustment model for Medicare Advantage plans for 2022. This move is required by the 21st Century Cures Act, and follows moves by the agency to phase in other risk models for MA payments.
From the September 14 press release from CMS:
CMS is...CMS Rules
CMS wants to increase the amount of encounter data the agency uses to calculate Medicare Advantage (MA) risk scores from 50% to 75%; final 2021 MA payment rates are expected on or before April 6.
Even as the industry continues to express concern over the reliability of encounter data, The HCC Risk Adjustment Model is now driven by...News
CMS wants to give Medicare Advantage (MA) plans more flexibility to offer previously non-covered supplemental benefits that will help chronic patients, adjust risk adjustment scores to reflect costs of beneficiaries with multiple conditions, and effectively raise the MA Revenue by 1.59 percent. Last year the revenue bump for plans...National News
The agency released Part 1 of the 2020 Advance Notice on Dec. 19; The Centers for Medicare & Medicaid Services (CMS) is proposing to include additional patient conditions when calculating risk adjustment payments for Medicare Advantage (MA) plans.
CMS also proposes to adjust its risk score calculation by boosting the weight of...White Papers, E books, Reports and more
The report examines the accuracy of the current CMS risk adjustment model for beneficiaries with functional limitations and the potential benefits of accounting for functional status in MA risk adjustment; and the potential challenges of accounting for functional status in risk adjustment.
Beneficiaries in poorer health are generally...
