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GAO: Medicare Overpaying for Medicare Advantage
A study by the Government Accountability Office finds differences in diagnostic coding between Medicare Advantage plans and traditional Medicare fee-for-service coverage.
These differences mean that Medicare Advantage beneficiary risk scores in 2010 were 4.8 percent to 7.1 percent higher than if those beneficiaries were continuously enrolled in fee-for-service, according to GAO, a congressional investigatory agency. And the higher scores translated in 2010 to $3.9 billion to $5.8 billion in higher payments to Medicare Advantage plans. Further, the coding differences increase over time, suggesting higher financial impacts in 2011 and 2012.
CMS estimates a lower level, 3.4 percent, of higher beneficiary risk scores in Medicare Advantage plans, translating to $2.7 billion in excess payments. GAO contends the CMS methodology does not include more current data, trending coding differences over time, or accounting for such characteristics as sex, health status, Medicaid enrollment status, beneficiary residential location, and disability.
Read more at:http://tinyurl.com/6t65zft
Source: Health Data Management
Laundromats as a New Frontier in Community Health, Medicaid Outreach
May 29th 2025Lindsey Leininger, PhD, and Allister Chang, MPA, highlight the potential of laundromats as accessible, community-based settings to support Medicaid outreach, foster trust, and connect families with essential health and social services.
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From Red Tape to Relief: Rewriting the Rules of Prior Authorization
June 23rd 2025Up to 257 million Americans could benefit from these prior authorization reforms that could have cross-market implications on health care plans administered through commercial insurers, Medicare Advantage, and Medicaid.
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New Research Challenges Assumptions About Hospital-Physician Integration, Medicare Patient Mix
April 22nd 2025On this episode of Managed Care Cast, Brady Post, PhD, lead author of a study published in the April 2025 issue of The American Journal of Managed Care®, challenges the claim that hospital-employed physicians serve a more complex patient mix.
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How Value-Based Care With Provider Enablement Improves Maternal and Infant Outcomes in Medicaid
June 12th 2025Supported value-based care improves prenatal care while reducing neonatal intensive care unit stays, preterm birth rates, low birth weight rates, and costs for mothers and infants.
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