Improve Medicare Advantage Payment Accuracy by Using Both Part A and B FFS Medicare Data
The Medicare Payment Advisory Commission (MedPAC) identified a growing trend in payment inaccuracy that could affect beneficiary access to affordable, high quality Medicare Advantage. MedPAC recommended that this inaccuracy would be corrected by using Traditional Fee-For-Service (FFS) Medicare data from individuals with both Medicare Part A and B to calculate the benchmark.
- CMS should improve Medicare Advantage payment accuracy by using only FFS Medicare data from individuals with both Part A and Part B for benchmark calculation.
- A Medicare Advantage beneficiary must be enrolled in both Part A and Part B.
- This change would likely result in a 1% increase in Medicare Advantage payments.
- An estimated 12% of FFS Medicare beneficiaries have only Medicare Part A or only Part B.
- Individuals with only Part A have much lower costs than beneficiaries with both Part A and Part B, which distorts the Medicare Advantage benchmark.