March 30, 2023
Payers | Tea Leaves
  • Bill Cassidy and Jeff Merkley introduced legislation to cut overpayments to Medicare Advantage plans by updating risk adjustment policies, with Cassidy saying in a statement that the bill will help squeeze out waste in the MA program. The legislation comes amid criticisms that MA plans inflate patients’ risk scores to make them appear sicker and then receive higher Medicare payments. Thebill would impose changes to MA risk adjustment and prevent Medicare from being charged for only relevant medical conditions. The bill would also enable the Centers for Medicare & Medicaid Services (CMS) to use two years of diagnostic data for developing a risk adjustment model instead of only one year. (Article here)