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AHIP asks CMS to change Medicare Advantage payment formula

By: | Tags: , , , | Comments: 0 | May 3rd, 2018

The Centers for Medicare and Medicaid Services should update its county benchmark calculation in the 2019 final notice being published April 2.

“America’s Health Insurance Plans is asking the Centers of Medicare and Medicaid Services to change the way the agency calculates Medicare Advantage payment rates, ahead of a final notice due out Monday. AHIP said it strongly believes CMS should update its benchmark calculation in the 2019 final notice. These reflect spending for enrollees with only Medicare Part A for care in hospitals and other facilities, enrollees with only Medicare Part B, which covers physician visits and medical supplies and enrollees with both Medicare Parts A and B. This method captures the expenditures of all Medicare beneficiaries, regardless of whether they’re in Part A, B or both. MA plans are required to provide coverage for all services included under both Parts A and B. AHIP said the cost data for beneficiaries who are only in Medicare Part A – for hospitalization – should be excluded from calculating MA payment rates. The Medicare Payment Advisory Commission has also recommended that CMS revise the calculation of benchmarks.” Read the full article.

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