How are Medicare Advantage Star Ratings calculated?

Medicare Star Ratings measures are primarily calculated based on Healthcare Effectiveness Data and Information Set (HEDIS) as well as Consumer Assessment of Healthcare Providers and Systems (CAHPS) data.

How are star ratings calculated CMS?

The Star Ratings are calculated based on a hospital’s performance on certain measures found on the Hospital Compare website. Hospitals submit data to the Hospital IQR, OQR, Value-Based Purchasing, Readmission Reduction and HAC Reduction programs. That information is published on Hospital Compare.

How CMS star ratings will affect your revenue?

As part of the ACA, CMS introduced a quality bonus payment (QBP) for MA organizations. Plans receive a bonus payment based on their qual- ity star rating equal to a percentage increase in the plan-wide benchmark payment rate1. This bonus payment increases the CMS revenue that a plan will receive.

What is quality bonus payment?

QBPs are additional bonus payments MAOs can earn if they achieve high scores on a variety of quality metrics (commonly known as the MA star rating). MAOs use these additional bonus payments to offer enhanced benefits to their beneficiaries.

What are the CMS Star measures?

CMS Star ratings include quality of care measures such as Adult BMI, Controlling Blood Pressure, Breast Cancer Screening, Osteoporosis Management in Women Who Had a Fracture, Comprehensive Diabetes Care, Colorectal Screenings, and others. …

How do quality bonuses work?

Specifically, the ACA mandated that quality bonus payments (QBPs) be paid to all contracts earning 4 or 5 Stars in Medicare’s Star Ratings program. The ACA also tied rebates, a portion of the amount when plan bids fall below the benchmarks paid back to the plan, to Star Ratings.

Why are CMS star ratings so important to Medicare?

From a beneficiary, payment and compliance standpoint, the importance of CMS Star Ratings performance continues to increase. Moreover, highly rated plans are awarded Quality Bonus Payments (QBP) and higher rebates that allow them to provide additional supplemental benefits and lower premiums.

How are Medicare Part C and D STAR ratings calculated?

The Centers for Medicare & Medicaid Services (CMS) publishes the Medicare Part C and D Star Ratings each year to measure the quality of health and drug services received by beneficiaries enrolled in Medicare Advantage (MA) and Prescription Drug Plans (PDPs or Part D plans). The Star Ratings also reflect the

What makes a Medicare Advantage plan a star?

Medicare Advantage plans receive a star rating based on performance measures that are intended to help potential enrollees compare plans available in their area as well as encourage plans to compete based on quality.

How are Medicare Advantage contracts rated by CMS?

Highlights of Contract Performance in 2020 Star Ratings1 Medicare Advantage with prescription drug coverage (MA-PD) contracts are rated on up to 45 unique quality and performance measures; MA-only contracts (without prescription drug coverage) are rated on up to 33