Tag Archives: medicare advantage plans

2014 Holds Big Changes for the CMS-HCC Model

The purpose of the CMS-HCC model is to improve the accuracy in predicting the costliness of Medicare Advantage (MA) enrollees’ healthcare costs and to properly fund MA plans for those expenses. It isn’t a perfect model but it surpasses the … Read Full Post

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What We’re Reading – GAO recommends ending CMS bonus payment demonstration

From the GAO.gov website and different healthcare news websites. The Government Accountability Office (GAO), a nonpartisan investigative arm of Congress, recommends that CMS should discontinue its quality bonus program demonstration. The reasons are the budgetary impact, lack of data to … Read Full Post

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What We’re Reading – CMS overpaid Medicare Advantage (MA) by as much as $5.1 billion, according to the Government Accountability Office (GAO)

A report issued by GAO the week of March 7, indicates that CMS overpaid the MA program run by private companies by between $3.2 and $5.1 billion for the years 2010-2012. The overpayments were the results of CMS inadequately adjusting … Read Full Post

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Medicare ACOs: Risk Adjusted Reimbursement’s Mathematical Impossibility (Part 5)

So far in this five-part series on Medicare ACOs, we’ve explored the basics of the concept, the patients’ participation, the fundamentals of reimbursement as well as the provider’s role and incentives.  Recall that we explained in an earlier section that … Read Full Post

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Medicare ACOs: Medicare beneficiaries and the ACO (Part 2)

Last time, we reviewed some of the background information concerning ACOs and the objective of this care delivery model.  In this installment of the five-part series, we will begin where health care truly starts: the patient.  Medicare beneficiaries will be … Read Full Post

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HEDIS: Is Yours a Five-Star Health Plan?

To most patients, quality is amorphous; we know it when we see it. To a healthcare administrator, however, quality has a whole other meaning. It’s measurable, measured and a measure of the congruence of several factors.  In managed care, quality … Read Full Post

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CMS Risk Adjustment Data Submission Deadlines and Payment Schedule

The nature of capitation and the risk adjustment payment method requires specific deadlines for data submission that correlate to dates of service and affect capitation payments.  The Centers for Medicare and Medicaid Services (CMS) observes the following three deadlines each … Read Full Post

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