WASHINGTON – U.S. Senator Bill Cassidy, M.D. (R-LA) discusses his plan to stop Medicare overpayments during U.S. Centers for Medicare and Medicaid Services (CMS) Director nominee Mehmet Oz’s confirmation hearing before the U.S. Senate Finance Committee. Dr. Oz said he agrees with Cassidy there are opportunities to stop Medicare Advantage plans from receiving higher Medicare reimbursements simply if a patient has multiple conditions regardless of whether they are related to the care they receive.
“[A]s we look at the [Medicare] trust fund going insolvent and our budget deficit expanding, is [Medicare Advantage] a place you would look? And if so, how would you look in terms of getting better value for the dollar?” asks Dr. Cassidy.
“I think there are ways for us to look for example at the upcoding that is going on that is happening systemically… to make sure people are being appropriately paid for taking care of sick patience, but not for patients who aren’t ill,” said Dr. Oz. “We actually have to go after places and areas where we are not managing the American people’s money well… both of us, I think, agree there are opportunities to do that.”
“I have a bill—the No UPCODE Act—that actually achieves that. So, I think you are going to be confirmed, and we will discuss that with you at a later date,” said Dr. Cassidy.
Last Congress, Cassidy introduced his No UPCODE Act to improve the way Medicare Advantage plans assess patients’ health risks, reduce overpayments for care, and save taxpayers billions by eliminating incentives to overcharge Medicare for care.
Background:
Traditional Medicare plans reimburse providers for the cost of treatments rendered, while Medicare Advantage is paid a standard rate based on the health of an individual patient. Because of this, Medicare Advantage plans have a financial incentive to make beneficiaries appear sicker than they may be to receive a higher Medicare reimbursement.
The No UPCODE Act would eliminate those incentives by:
- Developing a risk-adjustment model that uses two years of diagnostic data instead of just one year.
- Limiting the ability to use old or unrelated medical conditions when determining the cost of care.
- Ensuring Medicare is only charged for treatment related to relevant medical conditions.
- Closing the gap between how a patient is assessed under traditional Medicare and Medicare Advantage.
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