MedPAC, the group that advises Congress on Medicare issues, says it supports the Centers for Medicare and Medicaid Services’s (CMS) decision to change the scale used to adjust the reimbursement rate for Medicare Advantage (MA) plans based on a beneficiary’s level of sickness. This method is designed to prevent over- and underpayments. (Kaiser Network)
From MedPAC’s March 5 letter (PDF):
CMS is proposing an adjustment to risk scores to recognize differences between the coding practices in Medicare Advantage (MA) and those in the fee-for-service (FFS) sector of Medicare. CMS proposed the adjustment on the basis of findings from the
agency’s analysis of differences in the growth rate of MA enrollees’ risk scores compared to those of beneficiaries in FFS. CMS found that even after controlling for patient characteristics, risk scores were persistently higher for beneficiaries in MA. These higher risk scores—which result in higher MA payments—are presumed not to reflect differences in the health status of the two groups of beneficiaries, but rather differences in coding behavior.CMS proposes to reduce MA risk scores by 3.74 percent to recognize coding differences in the period 2008 through 2010. A final adjustment figure will be announced on April 6 (the date of the publication of the notice of MA rates), once CMS analyzes additional, more recent data. CMS has specifically asked for comments on its intention to limit the adjustment period to 2008-2010.
