The Centers for Medicare & Medicaid Services (CMS) has announced calendar year 2010 Medicare Advantage payment rates and policies. By law, CMS annually updates the Medicare Advantage capitation rates by a growth percentage that reflects growth in all Medicare expenditures, including expenditures under Part A and Part B payment rules. This growth percentage thus reflects the projected reduction in 2010 physician payments provided for under Part B payment rules. CMS announced that this amount for 2010 will be 0.81 percent.
For the first time, CMS will make a “coding pattern differences adjustment” to Medicare Advantage risk scores for plan year 2010, reducing Medicare Advantage payment rates to account for differences in disease coding patterns between Medicare Advantage organizations under Part C and the original Medicare program (Parts A and B). CMS is required by law to adjust Medicare Advantage rates where it finds differences in coding patterns between Medicare Advantage plans and Part A and Part B providers. The adjustment will be applied as a uniform 3.41 percentage reduction to all Medicare Advantage plans’ Part C risk scores in 2010.
In addition, the 2010 rates reflect a provision in recently enacted legislation requiring a multi-year phase-out of the inclusion of costs of indirect medical education in Medicare Advantage rates. The maximum reduction as part of this phase-out is approximately 0.60 percent per year.
View a fact sheet on the CMS announcement.
