HCC Coding Training: Introduction to Risk Adjustment Part 2

Medicare Advantage Start to Current — Enrollment Numbers: As of 2014, there is an estimated 54 million people in medicare in the US., of those 54 million, about 74% are enrolled in traditional Medicare and the remaining 30% are enrolled with a Medicare Advantage Plan.

Since 2004, the number of beneficiaries enrolled in private plans ha almost tripled from 5.3 million to 15.7 million in 2014.
2014 not only was a new year, but it meant that ACA was fully in effect and with that meant Plan denials for pre-existing conditions and underwriting would now become extinct. There is greater risk for higher mix of sick versus healthy individuals who are going to be covered by an MA Plan. This means that MA plans are going to have to manage their members care by coordinating with Plan Providers better than they have in previous years, with better MLR management and Member satisfaction for starters.

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