Quote:
Originally Posted by spinner1001
That source is not necessarily the sole source of MA-related revenues TVH might receive. As I said, Medicare Advantage is complex. It’s not a simple HMO capitation model for medical clinics. Incentive bonuses and shared savings payments from CMS are among other possible sources of revenue for a MA clinic.
Anything specific about TVH is speculation since the records are not public.
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TVH aside, is it safe to assume some of the revenue generated from upcoding is used by the Medicare Advantage Insurers to subsidize stuff like little to no monthly subscriber premiums, dental, hearing, vision, and other free stuff like health club memberships that aren’t available to those on traditional Medicare with a supplemental plan? It brings to mind the old adage, “if something seems too good to be true, then it’s most likely too good to be true”! There has to be a reason that Medicare pays, on average, 22% more per person on Advantage plans than traditional Medicare, despite the fact that people on traditional Medicare tend to be sicker and require more care? And if that is in fact the case, is it safe to expect the cost of Advantage plan premiums to increase and/or the benefits not available to traditional Medicare to begin to disappear?