Medicare Advantage Payment Rates and Changes for 2013: Strategies for Health Plans
22.05.12
Medicare Advantage plans and their partners have less knowledge than ever of what to expect in CMS’s “45-day notice” with the preliminary payment rates and call letter for 2013. While they know base payment rates will go down under the terms of the health reform law, they don’t know, for instance, to what extent those amounts might be altered by changes in the coding-intensity adjustment or risk-adjustment methodology. And the likelihood of changes for 2013 may be even greater with the GAO’s finding in late January that CMS’s risk-adjustment methodology is flawed and results in overpaying MA plans.
Also unknown is how CMS will factor into the rates the potential 2% payment cuts for MA plans under “sequestration” or the likelihood that Congress again will be unable to pass a long-term “doc fix.” Nor do they know how CMS will adjust for what has been the recent trend in fee-for-service costs. All that and much more figure to be addressed in the preliminary rate notice, after which MA sponsors will need to adjust their strategies quickly, recontracting with providers and suppliers where necessary, in order to be ready when 2013 bids are due June 4.
Source: Atlantic Information Services, Inc.
