Becker's Healthcare October 28, 2024
In the world of Medicare Advantage, hundreds of millions of dollars in health plan revenue can hinge on the success of one call.
Those dollars stem from star ratings, or how the federal government calculates the quality of Medicare Advantage plans using a system of 44 performance measures across 9 categories that lead to a final score of 1 (low) to 5 (high).
Star ratings determine whether plans are eligible for bonus payments from CMS, which can be used to enhance benefits and lower member’s costs, which can then lead to plan growth and a better member experience.
But if a plan sees lower revenue by way of low star ratings, benefits are usually lowered to maintain the company’s...
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