Medicare Advantage Program Standards Tightening
The most significant change on tap to the ratings system is expected to be an increase in the star threshold for bonus payments to health plans, based on a wide array of quality standards.
In addition to a widely anticipated cut to the Medicare Advantage payment rate in 2015, the Centers for Medicare & Medicaid Services are expected to announce Monday several changes to the MA five-star ratings program.
The most significant ratings change on tap to the ratings system is expected to be an increase in the star threshold for bonus payments to health plans, based on a wide array of quality standards.
When the star ratings program's three-year demonstration period comes to a close at the end of this year, three-star ratings will no longer make the bonus payment cut; four-star ratings will become the new gold standard.
The bonus payments are a "the big driver" of the MA star ratings program, according to Michael Kavouras, VP of star ratings at the Connecticut-based insurer, Aetna. "There are revenue opportunities for health plans," he said in a phone interview.
The pay-for-performance program can earn insurers a five percent bonus on top of the benchmark payment rate in the particular county or counties where an MA health plan is offered. The benchmarks set the maximum amount Medicare will pay a health plan in an area.
- 1 in 5 Eligible Hospitals Penalized for HACs
- 'Mega Boards' Could be Rural Healthcare Disruptor
- Two-Midnight Rule Will Cost Hospitals Big
- Meaningful Use Payment Adjustments Begin
- The Hospital of the Future is Not a Hospital
- HL20: Rebecca Katz—Cooking Up Sustainable Nourishment
- HL20: Peter Semczuk, DDS, MPH—Taking on the Big Challenges
- A Christmas Wish List for US Healthcare
- 12 Hires to Keep Your Hospital Out of Trouble
- PA hospital to pay $662,000 to settle Medicare fraud case