- Why accurate claims coding for MSSP ACOs has become increasingly important
By Jonah Broulette, Noah Champagne, Kathryn V. Fitch | 26 June 2018
This brief explains how benchmark year 3 risk scores affect the benchmark calculation for Medicare Shared Savings Program (MSSP) renewals, presents an overview of the prior and new MSSP benchmark calculations, and illustrates how the change can affect an accountable care organization’s benchmark under various scenarios.
- Don’t TrOOP off the cliff: True out-of-pocket amount poses challenges starting in 2020
By Van Phan, Todd M. Wanta | 20 June 2018
With significant changes to Medicare Part D from the Bipartisan Budget Act of 2018 and the Centers for Medicare and Medicaid Services Final Rule, one provision from the Patient Protection and Affordable Care Act that has gone largely unnoticed is the forthcoming TrOOP Cliff in 2020, for which plan sponsors should prepare.
- Are Medicare Advantage plans ready for the high costs of long-term care?
By Christopher J. Giese, Allen J. Schmitz | 12 June 2018
There are a number of factors that may influence how Medicare Advantage plans offer and price new long-term care benefits.
- Medicare Advantage and Part D: Compliance for actuaries
By Christopher S. Girod, Shyam Kolli | 30 April 2018
This paper focuses on one relatively narrow area of rules that is sometimes loosely referred to as actuarial compliance, and serves as a primer for actuaries or other professionals who are tasked with understanding and following these rules.
- The exclusion of some nursing facility visits from MSSP assignment has potential unintended consequences
By Kathryn V. Fitch, Cory Gusland | 16 April 2018
This article describes the changes in the historical benchmarks and performance expenditures for a number of Medicare Shared Savings Program accountable care organizations and also explains the possible impact of these changes.
- An Overview of the Bundled Payments for Care Improvement Advanced Model
By Samuel Bennett, Pamela M. Pelizzari | 13 March 2018
This paper outlines the major provisions of the newly announced Bundled Payments for Care Improvement Advanced model.
- State of the 2018 Medicare Advantage industry: Stable and growing
By Julia M. Friedman, Brett L. Swanson | 28 February 2018
This report highlights key changes in beneficiary premiums and benefits for the 2018 Medicare Advantage (MA) market as well as the reasons for and the magnitude of the decrease in value added within the MA market between 2014 and 2016 and the increases in value added in 2017 and 2018.
- Medicare Advantage star ratings: Expectations for new organizations
By Kelly S. Backes, Julia M. Friedman, Dustin J. Grzeskowiak, Elizabeth Phillips, Patricia A. Zenner | 23 February 2018
Organizations entering the Medicare Advantage market should be aware of the current star rating climate as well as short- and long-term star rating and revenue considerations.
- How will the Bipartisan Budget Act of 2018 impact Part D in 2019 and beyond?
By Adam Barnhart, Gabriela Dieguez, David R. Mike | 16 February 2018
Key changes to the Medicare Part D program will affect the donut hole in 2019, and this paper discusses the implications for stakeholders.
- Medicare Advantage’s transition from RAPS to EDS risk scores: 2017 impact
By Deana Bell, David Koenig, Charlie Mills | 09 February 2018
In 2017, many changes came to Medicare Advantage risk adjustment as the transition continued from Risk Adjustment Processing System data to Encounter Data System data.