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Insurers Game Medicare System to Boost Federal Bonus Payments - WSJ
Insurers Game Medicare System to Boost Federal Bonus Payments
A spokesman for the Centers for Medicare and Medicaid Services, which had proposed a change similar to the one in the budget package, says that the agency “reviews requests for contract consolidations based on current requirements.” Last November, the Medicare agency proposed changing the methodology “so that we can address the continued increase in the number of Medicare Advantage beneficiaries being moved from lower Star Rating contracts that do not receive a quality bonus to higher Star Rating contracts that do receive a quality bonus.”
The bonus system was created by the 2010 Affordable Care Act. The intention of the ratings was to provide guidance to people shopping for plans, and the payments were supposed to create additional incentive for providers to upgrade the quality of their offerings. The system measures such factors as whether members get proper screenings and vaccines, and the quality of customer service provided by insurers. Plans that win four or more stars are entitled to bonus payments.
The stars are applied to insurers’ contracts with the Medicare agency. Each contract can contain dozens of plans covering thousands of members. If plans in a low-rated contract are moved—or crosswalked—into a contract with a high rating, the high rating automatically applies to the newly added plans.
Insurers Game Medicare System to Boost Federal Bonus Payments
A spokesman for the Centers for Medicare and Medicaid Services, which had proposed a change similar to the one in the budget package, says that the agency “reviews requests for contract consolidations based on current requirements.” Last November, the Medicare agency proposed changing the methodology “so that we can address the continued increase in the number of Medicare Advantage beneficiaries being moved from lower Star Rating contracts that do not receive a quality bonus to higher Star Rating contracts that do receive a quality bonus.”
The bonus system was created by the 2010 Affordable Care Act. The intention of the ratings was to provide guidance to people shopping for plans, and the payments were supposed to create additional incentive for providers to upgrade the quality of their offerings. The system measures such factors as whether members get proper screenings and vaccines, and the quality of customer service provided by insurers. Plans that win four or more stars are entitled to bonus payments.
The stars are applied to insurers’ contracts with the Medicare agency. Each contract can contain dozens of plans covering thousands of members. If plans in a low-rated contract are moved—or crosswalked—into a contract with a high rating, the high rating automatically applies to the newly added plans.
