Description: Congress has been debating a revision to Medicare Advantage payments including limiting payments to the Medicare Fee-For-Service FFS cost. A county-specific impact study to the benchmark payment rates for each county nationally based on the FFS limitation criteria was performed. This article includes results for Florida, California, Pennsylvania and New York.

Description: Discussion of Medicare's Ambulatory Payment Classification APC system as the standard for reimbursement of non-capitated outpatient hospital services with sample calculations. Issue No. 37.

Description: Risk adjustment is used to adjust the revenue stream to health insurers that sell ACA eligible plans and Medicare Advantage plans. This article compares and contrasts these risk adjustment programs.

Description: This article reviews the Medicare Prescription Drug, Improvement and Modernization Act and the impact the legislation has had on Medicare Supplement plans, policies and the changes to the model regulation. From Health Section Newsletter, March 2005, Issue No. 49.

Description: Updates on the efforts of the Academy’s health practice council. its work groups and task forces, to educate health care policymakers on issues including principles for reform, Medicare, the individual insurance market, and risk factors.

Description: Strategies to position Medicare Advantage plans for success during August resubmission.

Description: A summary of the driving forces behind, and effects of, the historical increases and future expectations of Generic Dispensing Rates.

Description: Identifying and submitting all appropriate ICD-9 diagnosis codes to CMS will result in a higher risk score for the member and increased payments to Medicare Advantage plans. Milliman's HCC prevalence study illustrates the significant variations in HCC prevalence rates by age/gender, geography, and population type and will assist plans in benchmarking the effectiveness of their own diagnosis code capture efforts.