Could MSP validation solutions boost year-end financial results for Medicare Advantage plans?

As Q4 begins (could it be true?), my colleagues and I are busy preparing our 2016 wish lists and calculating the budgets to support them.  As an executive team, we’ll spend the next several weeks taking a hard look at our results for the year so far and make some tough decisions about our financial plan for the next year.

I bet your plan’s executives are in the same boat. They’re reviewing the year behind and planning for the year ahead. Where is the plan succeeding? Where is it falling short? Which new initiatives will make into the next year’s budget? Which will have to wait?

As the year comes to an end, what can your plan do to boost results for the current year or get a head start financially for 2016? Consider taking a look at Medicare Secondary Payer (MSP). CMS premiums have a direct impact on your bottom line and there’s a good chance that you’re not receiving the full premiums you’re owed. In fact, you may be getting shorted by millions of dollars in premiums due to MSP. And even if your plan is already validating open MSP records to ensure correct primacy, you still may not be seeing all the opportunities to restore premium revenue.

My team at Discovery Health Partners worked with 16 Medicare Advantage plans over the last two years to restore $86 million in underpaid premiums. Many of these plans already had teams on the ground validating other insurance and attempting to correct erroneous CMS eligibility information in hopes of receiving premium adjustments. Roadblocks standing in the way of their success range from lack of focused resources and insufficient follow-up to a limited view of open MSP records (hint: you should be looking at ALL open records).

Within a matter of only a few months, we were able to help these plans restore millions of dollars to their bottom lines. This includes $20 million for a 96,000-member MA plan and $32 million for a 550,000-member MA plan. Even a 38,000-member MA plan was able to restore $13.4 million. What would an additional $10 million or $20 million mean to your plan’s financial performance?

By our calculations, Medicare Advantage plans as a whole are missing $2 billion in premium revenue. As MA membership quadruples over the next seven years, the problem (or shall I say opportunity?) will only increase.

If you’d like to learn more about how MSP validation may be able to provide that financial uptick you need at the end of the year, please reach out to me at my email address below. I’d welcome the opportunity to talk about our proven best practices and our low-risk contingency-based MSP solution.




Paul VostersCould MSP validation solutions boost year-end financial results for Medicare Advantage plans?