Description: This article makes organizations entering the MA market aware of the star rating climate, as well as short- and long-term star rating & revenue considerations.

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: Two Medicare risk funding provisions that were radically changed by the BBA of 1997 funding variations by geographic area and risk adjustment. Issue No. 36

Description: This article discusses future benchmarks of Medicare and Medicare's rising costs and its relativity to the actuarial profession.

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: What you need to know about risk scores to be competitive in the Medicare Advantage market.

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.

Description: Updates on the efforts of the Academy’s health practice council. its work groups and task forces, to educate and influence health care policymakers on issues including principles for health care reform, Medicare, wellness programs, and solvency.

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.