Medicare Advantage : changes improved accuracy of risk adjustment for certain beneficiaries : report to congressional requesters.

Format:

Book

Government document

Author/Creator:

United States. Government Accountability Office

Language:

English

Subjects (All):

Centers for Medicare & Medicaid Services (U.S.)--Rules and practice.

Centers for Medicare & Medicaid Services (U.S.).

Medicare.

Diagnosis related groups--Government policy--United States.

Diagnosis related groups.

Medicare Part C--economics.

Risk Adjustment--economics.

Fee-for-Service Plans--economics.

United States.

Medical Subjects:

Medicare Part C--economics.

Risk Adjustment--economics.

Fee-for-Service Plans--economics.

United States.

Medicare.

Genre:

Rules.

Physical Description:

1 online resource (ii, 34 pages) : illustrations

Other Title:

Changes improved accuracy of risk adjustment for certain beneficiaries

Medicare Advantage risk adjustment

Place of Publication:

[Washington, D.C.] : U.S. Govt. Accountability Office, [2011]

Summary:

The Centers for Medicare & Medicaid Services (CMS) pays plans in Medicare Advantage (MA)--the private plan alternative to Medicare fee-for-service (FFS)--an amount per beneficiary that is adjusted to reflect beneficiary health status. This adjustment, called risk adjustment, helps ensure that health plans have the same financial incentive to enroll and care for beneficiaries regardless of their health status. In 2010, CMS announced plans to revise the major medical conditions included in its principal risk-adjustment model--the community model--and add a model for new enrollees in chronic condition special needs plans (C-SNP), which target beneficiaries with certain severe or disabling chronic conditions. CMS began using the C-SNP new enrollee model in 2011, in place of the general new enrollee model, to adjust MA payments for new Medicare beneficiaries who enroll in a C-SNP. GAO was asked to examine the accuracy of these models for high-risk beneficiaries. Using data for a nationally representative sample of 2007 FFS beneficiaries, GAO computed the amount that expenditure estimates were above or below actual expenditures for 2007, the most recent data available at the time. GAO compared the accuracy of the current and revised community models for three high-risk groups: beneficiaries with multiple chronic conditions, with low income, and with dementia. GAO compared the accuracy of the general and C-SNP new enrollee models for new enrollees eligible to enroll in a C-SNP.

Notes:

Title from PDF title screen (viewed on Jan. 17, 2011).

"December 2011."

Includes bibliographical references.

"GAO-12-52."

OCLC:

773147320