Medicare Advantage plans will face tougher auditing standards after a highly-anticipated ruling from CMS. The program also hit 30 million members in recent weeks, and payers are expecting enrollment numbers to keep climbing.
Here are seven stories about Medicare Advantage Becker's has reported since Jan. 13.
- CMS will implement stricter audits of Medicare Advantage plans, a move that could leave payers on the hook for billions of dollars in repayments to the federal government. In a final rule issued Jan. 30, the agency said it will strike the fee-for-service adjuster from risk adjustment data validation audits, a tool that would have calculated a permissible level of payment errors and limited audit recoveries to payment errors above that level.
- In response to the new regulations, organizations representing payers said tougher auditing standards could create higher premiums and fail to target fraud. Others said the new rule doesn't go far enough.
- Humana could potentially face the largest penalties from the new rule, Bloomberg reported.
- Matt Eyles, president and CEO of AHIP, sat down with Becker's to discuss why Medicare Advantage plans are so popular among older adults and why he believes it's important to keep the program strong in the future.
- A plan to shift New York City retirees' coverage to Medicare Advantage has stalled indefinitely. Courts have blocked the city's proposal to charge retired city employees who opt out of a Medicare Advantage plan a $191 monthly premium. New York City Mayor Eric Adams has asked the city's council to change the city's laws to allow the fee, but council leadership has said it has no plans to vote on the bill.
- Over 30 million people are now enrolled in Medicare Advantage plans as of Jan. 1. The record enrollment marks a significant milestone for the public-private program.
- UnitedHealthcare is projecting 900,000 more Medicare members in 2023 across its individual, group and D-SNP lines of business.