Sunday Links

You’re a flipping genius!

 

 

Opioid prescribing in Medicare Advantage

The meat is behind a paywall, but the short version is that it hasn’t changed from 2011 to 2016.

Bonus: More than half of MA beneficiaries age less than 65 and disabled get regular opioid  prescriptions

All this despite the war on providers—things that make you go hmmmm.

 

 

 

Socio-economic Status and STAR Ratings

The more dual-eligibles you have, the harder it is to attain a high STAR rating—and an additional STAR means more revenue than does the higher capitation being shifted to  with dual-eligibles

Perhaps an adjustment for dual-eligible enrollment is in the offing?

 

 

Capitation adjustment based on ADLs

The CBO says capitation payments could be more accurate if they take into account ADLs.  Perhaps, but the potential for fraud staggers the mind.

 

 

United Healthcare gets Federal Court to strike down 2014 Overpayment rule

There is now literally no enforcement mechanism for over-coding and any new overpayment rule is unlikely to be enforced retroactively—-so code away!

 

 

Medicare Supplement Use Rises Again

Given the new restrictions on first dollar coverage coming in 2019, I doubt we will ever be able to say such a thing again.

 

 

 

Hospice “Carve-ins” for Medicare Advantage “inevitable.”

Carve-ins for a lot of things are inevitable. Best get coding and take good care of your patients.

You’re going to need the revenue.

 

 

Tomism

“All you need for a high-performing Medicare Advantage plan are primes with skin in the game. Everything else will flow from that.”