With less funding available, health plan providers need accurate HCC Coding to maximize reimbursements
The Affordable Care Act, aka Obamacare, has slashed funding for Medicare Advantage by $156 billion over a period of 10 years. One prominent industry analyst estimates that this change will mean a 7 to 8 percent reduction in Medicare Advantage reimbursements available to health plan providers in 2014.
Cutting Plan Offerings
Many health plan providers have reacted to this news by cutting back on their Medicare Advantage offerings, canceling doctor contracts and cutting plan offerings. Based on data from the Center for Medicare and Medicaid Services, consulting company Avalere Health has projected that whereas before Obamacare the total number of Medicare Advantage plans was on the rise, now the number will decrease by 5.3 percent between 2013 and 2014. Residents of many counties across the country will see their plan options decrease, with reductions occurring in 80 percent of southern and Midwestern counties and 50 percent of northeastern and western counties.
Remaining Plans Raise Prices
Of the Medicare Advantage Plan offerings that remain, many will feature increased premiums and prices to compensate for Obamacare cuts. To cite just one example, a member of the Aetna Medicare Advantage Standard HMO plan in West Philadelphia will pay $75.50 per month for coverage in 2014, which is nearly double the rate for 2013 ($39).
Slimmer Pickings for Reimbursements Make Accurate Coding Vital
Maximizing Medicare Advantage reimbursements has always been a priority for health plan providers, but with less cash available to the program it is now more important than ever for health plan providers to ensure that they get their fair share of the pie when it comes to this vital funding. Contracting with HCC Coders can help. We assist health plan providers in maximizing their reimbursements by ensuring highly accurate coding. We do this via a combination of services, including prospective risk adjustment coding, which allows us to work ahead and ensure deadlines are met. All of the coders that we provide are fully trained in HCC coding, as well as in the new ICD 10 code set, enabling health plan providers who choose us for their risk adjustment coding to avoid the potential stumbling blocks that this new code set presents. We can also provide health plan organizations with access to our proprietary software, HCC Navigator, which can improve their HCC coding workflow even if they choose to use their own coders rather than ours.
Remember, at HCC Coders we fully understand the challenges that health plan providers face in this changing health care landscape. We will do everything in our power to help ensure that you receive your fair share of the decreased Medicare Advantage funding so that you can continue to provide your enrollees with quality care at an affordable price.