The CMS has proposed increasing health insurers' Medicare Advantage payment rates by 1.05% for 2016, a move that kicks off a 45-day dogfight in Washington before the rates are cemented.
The base rate was a 0.95% decrease, but “when combined with expected growth in plan risk scores due to coding,” Advantage plans will actually receive the 1.05% hike in revenue next year, according to a release from the CMS posted late Friday afternoon. Risk scores relate to how Medicare pays for the health status of beneficiaries. The CMS pays more for patients who have more health conditions and less for those who are healthier.
Comments on the proposed rates are due by March 6. Final rates will be released April 6.
The preliminary 2016 rates differ from the 2% rate increase preview the CMS issued in December. But Sean Cavanaugh, the CMS' director of the Center for Medicare, said the payments were “fair” and would “minimize disruptions to beneficiaries.”
Breaking from proposals in the previous two years, the CMS said it would not propose any adjustments to the use of home visits for patient-risk assessments. Many Advantage plans diagnose the severity of patients' illnesses at home instead of in a physician's office. But this has raised concerns that many plans are falsely inflating their diagnoses in a bid to justify higher payments for sicker members, a process called upcoding.
Health insurers have already begun their Medicare Advantage lobbying campaign and many members of Congress have also weighed in on the process.