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Medicare Advantage Payment Rate

CMS has made its final ruling on the Medicare Advantage Payment Rate and it has been appreciated by AHIP. According to the reports published by CMS, the Final Medicare Advantage payment rates proposed for the coming year are lower as compared to the same proposed by the government last February.

CMS also revealed a lot of facts and suggestions about its future plans in improving the Medicare plans in the report. As such, it said that there would be an increment of about 0.85 percent in the payment to the insurers, which is again, less than what was proposed a few months ago. In the proposal that CMS issued in February, the proposed hike in the payment was 1.35 percent.

The lower rate in the newly proposed plan is designed to offset the current expenditure. The policy changes that CMS proposed earlier seem to work out. The estimated expenditure is taken as a total. The idea is that it would then be less than what is expected in the policy changes suggested in February. According to the AHIP reports published recently, if it were to be included in the earlier plans, it would have caused an overall decline of 0.5 to 3.9 percent cut in Medicare Advantage payments.

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Medicare Advantage Payments

Meanwhile, President and CEO of AHIP, Marilyn Tavenner, said that she was happy with the proposed policies and rates by CMS. She noted that “Medicare Advantage is a lifeline for more than 17 million seniors across the country with beneficiaries facing new cuts to their coverage, more than 400 Members of Congress – the most support ever for the program – stood up to protect beneficiaries’ benefits.”

Notwithstanding this, the latest rise of 0.85 percent in the payment rate hike will not make any difference in the additional 2.2 percent of health plans. CMS thinks that this coding acuity was supposed to be added from basic systems. At the same time, some reports indicate that there was pressure from AHIP to retain the current rates.

Most of the senior players would face cuts to their coverage if the current trend continues to persist. During the meeting, CMS also said that it was not supporting the new model of retrieving data, although many companies were using them for estimating the level of risk scores. Understandably, the new policies that have been proposed now will be used to rectify the issues with the accuracy of payments to Medicare Advantage plans.