Now with the risk adjustment program, the payments from patients with multiple diseases are likely to increase, compared to what they were in the past. This program emphasizes that the providers of the Medicare Advantage Plan need to revise the list of customers they offer their services to on a regular basis. They also need to attract doctors and physicians who are capable of treating patients with different diseases effectively. Since many patients suffer from diabetes, chronological illness and heart disease, hospitals and medical facilities should design programs that address the needs of patients with these diseases as well.
Video: Medicare Physician Feedback Program: Payment Standardization and RIsk Adjustment
All About Medicare Risk Adjustment
The Medicare Risk Adjustment program was launched in 2000 by the Centers for Medicare and Medicaid Services (CMS) to compensate managed care organizations. This program gathers information of treatment offered to patients in different facilities and on the basis of this information, Medicare determines how much to pay them. For this purpose, CMS uses ICD-9 codes to indicate different treatments and prepares a comprehensive report. The payment structure determined by using this system is more accurate and reliable compared to what it was earlier because the previous system relied only on geographic and demographic information to determine compensation of a facility.
House Republican Plan to Overhaul Medicare Opposed by Original Advocate
While Ryan’s plan does put a limit on the number and variety of plans that insurance companies could offer, it’s important to consider a few things. A full 25 percent of beneficiaries are already enrolled in private plans through Medicare Advantage. In 2012, however, Medicare will still spend 7 percent more for beneficiaries enrolled in Medicare Advantage plans than if those beneficiaries were in traditional Medicare. And as Center for American Progress Managing Director of Health Policy Topher Spiro has argued, “There is no evidence that private plans provide better quality than traditional Medicare, and the quality of private plans is highly uneven.” The example of Medicare Advantage demonstrates that premium support plans would likely cost more without guaranteeing increased quality of care.
Medicare Risk Adjustment – A Brief Input
Medicare Risk Adjustment is a term used to describe about the payment method authorized by Balanced Budget Act of 1997 & utilized by the Centers for Medicare & Medicaid Services (CMS) to make improvements in payment accuracy to Medicare Advantage Organizations. However, to make such methodology be effectively possible, the ICD-9 coding plays the big part of the process. ICD-9 coding determines the degree of severity of patient’s health condition through its numerical indexing of illness diagnosis, hospital procedures and other pertinent clinical data. From such system, Medicare risk adjustment can analyze and provide the appropriate allowable funds that is to be reimbursed to physicians and amount that can be covered during hospitalization.
GAO report on Medicare Advantage risk adjustment
We found that diagnostic coding differences exist between MA plans and Medicare FFS and that these differences had a substantial effect on payment to MA plans. We estimated that risk score growth due to coding differences over the previous 3 years was equivalent to $3.9 billion to $5.8 billion in payments to MA plans in 2010 before CMS’s adjustment for coding differences. Before CMS reduced 2010 MA beneficiary risk scores, we found that these scores were at least 4.8 percent, and perhaps as much as 7.1 percent, higher than the risk scores likely would have been as a result of diagnostic coding differences, that is, if the same beneficiaries had been continuously enrolled in FFS. Our estimates suggest that, after accounting for CMS’s 3.4 percent reduction to MA risk scores in 2010, MA risk scores were too high by at least 1.4 percent, and perhaps as much as 3.7 percent, equivalent to $1.2 billion and $3.1 billion in payments to MA plans.
LeadingAge: MedPAC June 2012 Report: Recommendations on PACE Expansion
After the changes in Recommendation 1 take effect, the secretary should establish an outlier protection policy for new PACE sites to use during the first three years of their programs to help defray the exceptionally high acute care costs for Medicare beneficiaries. The secretary should establish the outlier payment caps so that the costs of all of this chapter’s recommendations do not exceed the savings achieved by the changes in Recommendation 1.