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Medicare may penalize Advantage plans for faulty provider lists
Modern Healthcare: The CMS plans to more closely monitor Medicare Advantage insurers' provider networks and may fine or otherwise sanction plans that don't accurately show which doctors are available at in-network prices.
New provisions related to provider networks and directories were included in the agency's proposed 2016 rate notice (PDF), released last Friday. Medicare Advantage payments will drop 0.95% on average, but when accounting for higher risk scores based on coding patterns, health plans on average will receive a 1.05% increase.
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