- Medicare Advantage (MA) payment rates will increase by an average of 0.45% for 2018, the CMS announced Monday.
- The agency will adjust its use of encounter data in determining risk scores for plans. The new score blend will take provider information about the care an enrollee received for 15% - not 25% - of the risk score.
- However, the CMS did not fix a glitch that limits incentive payments insurers receive for providing high quality care in MA plans.
The average of 0.45% is a slight increase from the increase of 0.25% the CMS has proposed in February, which the Alliance of Community Health Plans said “will allow member plans to continue providing stronger benefits to 2.4 million seniors in Medicare Advantage plans.”
The ACHP denounced the inaction on the incentive payment glitch, stating the CMS has the authority to make the fix because of a presidential executive order from January and should do so because it “is crucial that Medicare Advantage policy incentivize quality and value in care.”
MA plans are popular and growing, but have been in the news lately mostly because of fraud concerns. A Government Accountability Office report from a year ago found the CMS overpaid MA plans by more than $14 billion in 2013 from unsupported diagnoses.