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MA Plans Should Ready For Changes To Risk Adjustment Submissions?
Provider groups, anti-Medicare Advantage (MA) advocates and researchers, and even the congressional policy arm MedPAC are busy attacking MA for supposedly being over-reimbursed. Depending on the study you find, these folks will tell you that MA is over-reimbursed by as much as $88 billion annually. Of course, many of these calculations are speculative and throw in policy decisions by Congress to make Stars funding additive as well as to pay some areas of the country more than the fee-for-service (FFS) rate to promote more benefit choice in rural areas. They argue that risk adjustment coding is out of control and that MA has beneficial selection compared with the traditional program. I have told you often in these pages that I come somewhere up the middle here. I discount the critics’ views and analyses. It is strange that critics’ overpayment estimates jumped from under $20 billion for so many years to