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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.