Medicare Advantage
Expert articles and analysis related to medicare advantage.
AI Summary — Last 30 Days
In the past 30 days, CMS has signaled a shift in Medicare Advantage (MA) policy, specifically aiming to keep MA rates flat for the coming year while altering risk adjustment calculations, a move that prompted significant feedback from insurers source. This comes amid a surge in Special Needs Plan (SNP) enrollment, which has increased by 23% over the past two years, indicating a substantial trend that may necessitate reevaluation of risk contracts by providers source. Additionally, high-profile risk adjustment disputes, like Aetna's recent $117.7 million settlement over diagnosis code inaccuracies, underscore the operational pressures on insurers within the evolving MA landscape. These developments highlight the critical need for providers to adapt to shifting payment models and regulatory expectations in value-based care.
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Considerations for implementing Medicare Advantage encounter data in risk adjustment - MedPAC (.gov)
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