HCC Coding Training: Introduction to Risk Adjustment (Part 3)

There are several types of MA Plans that are offered to potential enrollees annually to deliver benefits, including various HMOs, PPOs, Private Fee-for-Service (PFFS), etc. In 2014, HMOs dominated the market, followed by PPOs, as follows:

• HMOs come in first as they account for about 64% market share of total Medicare Advantage enrollment for 2014
• While local PPOs come in second with roughly 23% market share of total Medicare Advantage enrollees

Regional PPOs

Were initially established so that rural beneficiaries would have greater access to Medicare Advantage plans. Regional PPOs can either provide coverage statewide or can cover multi-state regions and they accounted for approximately 8% of all Medicare Advantage enrollees in 2014.

Private Fee-for-Service plans (PFFS),

Initially established in 1997, they did not have to sustain existing networks, however, since 2011, that has changed and they are now generally required to do so. Enrollment in PFFS enrollment skyrocketed from 2005, where it went from 0.2 million enrollees to a staggering 2.2 million in 2009, but took a dramatic downward spiral since then, with an overall enrollment of 0.3 million as of 2014, or roughly 2% of the market for total Medicare Advantage enrollees.

Learn more HCC Coding Training, HCC Coding Guidelines, HCC Coding Course and HCC Coding Certification at