'И не выиграл, а проиграл. И не в лотерею, а в лото. И не Петя, а Вася'.Catmint писал(а): ↑Чт окт 19, 2023 7:07 pm Зашла почитать обсуждение, что advantage отменяет бидон, а тут ничего нет. Никого не интересует или как? Тут я в основном про него читала. Я пока не разбираюсь, но насторожило, что после advantage практически обратной дороги нет. Ето я не то услышала, или не поняла, что будут делать люди, которые на advantage и его отменят?
Is the Biden Administration Proposing Cuts to Medicare Advantage?
Ну и 30.8 млн seniors (>51%, получающих Medicare, и почти 10% всего населения) подписаны на Medicare Advantage (ага, только тронь! кто бы это не был - Байден, Трамп, etc.What’s the issue? To improve program integrity, the RADV rule modifies how CMS calculates the amount a plan is required to pay back to the federal government when diagnoses codes submitted for risk adjustment are not supported by information in the medical records. Risk adjustment is a process where payments to plans are adjusted based on the health status of their enrollees. Under the finalized rule, CMS will extrapolate error rates in the audit sample to the full contract – a practice common to other audits, but not previously included in the RADV program. CMS estimates that it will collect $4.5 billion over the next decade by applying this and other changes to audits starting with plan year 2018 (though no new collections will come in until 2025). These are recouped payments that should not have been made in the first place, based on an extrapolation of audited records.
In addition, the Administration is proposing to modify Medicare Advantage payments for the upcoming plan year, as it does every year when it publishes the annual notice of proposed changes to Medicare Advantage payments. The proposed changes are largely technical adjustments that update the payment formula to account for changes in the economy, as well as Medicare spending trends. In addition, the Administration proposes to make revisions in how risk scores are calculated.
Despite the expected net increase in Medicare Advantage payments in 2024, overall and per enrollee, some industry stakeholders are focusing specifically on changes to the risk adjustment model, rather than the total change in payments for 2024. The proposed changes to the risk adjustment model address higher “coding intensity” (incentives for Medicare Advantage plans to code more intensely than traditional Medicare) that will result in $23 billion in excess payments in 2023, according to MedPAC. Specifically, CMS proposes updating the conditions used to predict expenditures, similar to revisions made in previous years, as well as transition to ICD-10 diagnoses codes, consistent with the system currently used in clinical settings. CMS estimates that the changes made to the risk adjustment model will result in payments to Medicare Advantage plans that are $11 billion lower in 2024 compared to the status quo, before taking into account other proposed changes and underlying trends that are expected to result in a net increase in per enrollee and total payments.
): Medicare Advantage in 2023: Enrollment Update and Key Trends
