The recent news of a slight decrease in Medicare Advantage (MA) benchmark payments for 2025 has caused concern within the payer industry. While CMS maintains the finalized rates will ensure program stability, many insurers fear insufficient coverage for rising costs. CMS recently announced that reimbursements and revenue for healthcare providers would increase under the new coding trend. However, it is becoming increasingly challenging to keep up with these new coding regulations every year, which may impact the rate at which reimbursements increase. Organizations without adequate systems and platforms will have difficulty meeting targets. This is where evaire, an ECLAT Health Solutions company, can step in and offer valuable support.
Challenges Presented by Reduced Benchmark Payments
The 0.16% decrease in benchmark payments, coupled with projected declines in star rating bonuses, creates a financial squeeze for MA plans. The impact of v28 will be seen in July payments related to the March sweep.
This can lead to:
- Reduced Supplemental Benefits: Insurers may be forced to reduce the valuable extras offered to beneficiaries, which could impact patient care and satisfaction.
- Increased Cost Sharing: Beneficiaries may see higher deductibles, copays, or coinsurance, potentially hindering access to necessary treatments.
How evaire Can Help
- Improved Risk Adjustment Capture: evaire's expertise in risk adjustment helps identify and capture all relevant patient conditions, leading to more accurate risk scores and potentially higher revenue.
- Cost-Containment Strategies: evaire can help identify areas for cost savings within your MA plan's operations, freeing up resources to maintain vital benefits and services.
Maintaining Stability and Growth with evaire
By partnering with evaire, MA plans can navigate the challenges of reduced benchmark payments and ensure continued program stability. Through a combination of coding accuracy, risk adjustment optimization, and efficient revenue cycle management, plans can provide financial stability while continuing to offer robust and affordable healthcare options to their beneficiaries.
