Senate Bill has major changes to MA

The Senates Patient Protection and Affordable Care Act contains significant changes to Medicare Advantage Plan payments. By 2015, plan payments will be determined by enrollment weighted average bids for local MA plans. Currently, payments are determined based on local benchmarks. The new system uses a competitive bidding system, and is expected to lower costs by $118 billion over ten years.

The Senate Bill differs markedly from the House Bill, which calls for MA payments to be equal to the average per capita costs under Fee For Service. The House Bill is expected to lower costs by $170 billion over ten years.

Regardless of which approach is in the final bill, payments to MA plans are going to be significantly reduced over a ten year period. Plans should start preparing now to determine how these changes might affect them, and how it might impact the benefits they will offer going forward.

Free Offer from Veracity Data Systems

With the January 31st, 2010 final deadline looming for submission of 2008 encounter data, Veracity Data Systems is offering a free year over year analysis of your 2008 and 2007 HCCs. Provide us with a recent MMR, a final 2007 Model Output data file, and a Model Output data file from the second half of 2009, and we'll provide you a listing of missing HCCs and the financial impact those HCCs would have on your bottom line if they were submitted. This report will help you start to identify and target your efforts for revenue enhancement. For complete information about this offering, use this link.

MA Coding Intensity

Medicare Advantage Plans will be subject to a Coding Intensity Adjustment in 2010. This adjustment will decrease risk scores of all members by 3.41%. This adjustment is in addition to the normalization factor that is applied to risk scores, which will be set at 1.041 for aged and disabled members. This new adjustment is designed to reflect the differences between FFS and MA risk scores due to more intense coding of MA members.

For more information about these adjustments, see the CMS Advance Notice and Final Notice for 2010.

CMS Advance Notice 2010

CMS 2010 Announcement

Welcome

This is the first post of the new Veracity Data Systems Blog! We welcome you and encourage you to visit regularly or subscribe via RSS feed.

-The Veracity Data Systems Team