Being Better than “Them,” the $250 Million Star, and 24 Hours for Medicaid Admissions

ICD10monitor June 12, 2024
Ronald Hirsch, MD, FACP, ACPA-C, CHCQM, CHRI

Let’s start with a recent court case. SCAN health plan, a Medicare Advantage (MA) plan, recently sued Medicare because their star rating dropped from 4.5 to 3.5.

They claimed that Medicare’s method for calculating the rating was contrary to the regulations. Well, SCAN won the case, and as a result, they will receive an additional $250 million bonus. If anything says how flawed the Medicare Advantage program is, it is the fact that one star is worth that much money. Imagine the care that could be provided with $250 million. Now, MA plans’ expenditures are regulated with a medical loss ratio, so all that money won’t go to executive bonuses, but still… And remember that patient complaints affect star ratings,...

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