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As a subscriber you can listen to articles at work, in the car, or while you work out. Subscribe NowThe Biden administration is planning to adjust the Medicare Star Ratings System to lower the impact of call center scores, Bloomberg News reported.
The call center scores have been the subject of several lawsuits filed by several health insurers—including Indianapolis-based Elevance Health—and managed care firms in recent months.
A number of private Medicare Advantage insurers have sued the Centers for Medicare & Medicaid Services to contest their 2025 “star ratings,” which determine how much they’ll receive in 2026 from the Medicare Advantage Quality Bonus Payment program, Bloomberg News reported Wednesday.
The bonus payments, which can amount to hundreds of millions of dollars, go to Medicare Advantage insurers that earn at least four of a possible five stars on a list of quality measures.
Under the Star Ratings system, Medicare Advantage and Part D pharmacy plans with four or more stars can receive annual bonus payments. Several measures, including call center scores, are used in rating calculations.
The call center scores are “going to have a smaller weighting on star ratings moving forward,” Deputy CMS Administrator Meena Seshamani said Wednesday at the Milken Institute’s 2024 Future of Health Summit, Seeking Alpha reported.
Plans are underway to adjust how to arrive at call center scores, Seshamani noted, adding, “It just sometimes takes time for these things to work their way through because of, you know, constantly looking at the methodology.”
In September and October, UnitedHealthcare and Centene sued the Medicare administrator, the Centers for Medicare & Medicaid Services, for unfairly downgrading their 2025 Star Ratings based on the call center measure.
Separately, Elevance Health last month sued the federal government over Medicare Advantage star ratings that it called “arbitrary and capricious.”
The suit follows litigation by other insurers, including UnitedHealth Group, Humana and Centene.
At stake are billions of dollars in bonuses that CMS awards to insurers that achieve a certain start rating on their Medicare Advantage scores.
Elevance, formerly known as Anthem Inc., said Medicare’s calculation methodology was fraught with statistical variance, which can cause improper impacts on a health plan’s overall star rating, the lawsuit said.
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