Hi all,
I have unfortunate news to share.
It turns out that Medicare Advantage plans can apply the HHVBP payment increase and decreases if it’s written in your contract. I’d check w/ your payer contracting to make sure your contracts do not state adherence to the Medicare FFS
rules.
We’ve been going around and around with Prime West and Ucare trying to get answers on this.
Thank you Paulette for the connection at NAHC. Just thought I’d share my findings!
Jessica Kirchoff OTR/L, MBA
Manager, Quality & Compliance – Home Health
Allina Health Home Health • Allina Health Commons
Office Phone: 612-262-7734• Mobile 612-810-4420 • Fax: 612-262-7643
Mail Route 10733 • 2925 Chicago Avenue • Minneapolis, MN 55407
From: Mary Carr <mcarr@allianceforcareathome.org>
Sent: Monday, March 31, 2025 10:34 AM
To: Kirchoff, Jessica L <Jessica.Kirchoff@allina.com>
Subject: [External Mail] RE: Medicare Advantage and HHVBP Penalty
Hi Jessica
I have heard from others that they are observing this as well. There are no restrictions preventing plans from applying the HHVBP adjustment. Payments to in-network providers are made in accordance with the
contract between the two parties, which may include a general provision requiring adherence to FFS Medicare rules. If plans choose to apply the adjustment, they should implement both percentage increases and decreases."
Mary Carr, RN,MPH
V.P. for Regulatory Affairs
mcarr@allianceforcareinthehome.org / O: 202-567-7424
From: Kirchoff, Jessica L <Jessica.Kirchoff@allina.com>
Sent: Monday, March 31, 2025 10:42 AM
To: Mary Carr <mcarr@allianceforcareathome.org>
Subject: Medicare Advantage and HHVBP Penalty
|
You don't often get email from
jessica.kirchoff@allina.com.
Learn why this is important |
Hi Mary,
Our agency has a question on Medicare Advantage plans and the HHVBP penalty. 2025 is our first payment/penalty year, here in Minnesota. We seem to have two payers that appear to be withholding the HHVBP penalty % on claims.
Everything on the CMS website says the penalty will only be applied to Medicare FFS claims. I even reached out to CMS directly and confirmed.
Do you know in the initial states that went live with HHVBP if the penalties were applied to all Medicare FFS AND Medicare Advantage claims?
We have reached out to the two payers (Ucare and Prime West) and are not getting responses back as to why they are withholding the % of payment. If the penalty will be applied to Medicare Advantage claims as well, this will hit agencies
very hard.
Thank you for any information you can provide!
Jessica Kirchoff OTR/L, MBA
Manager, Quality & Compliance – Home Health
Allina Health Home Health • Allina Health Commons
Office Phone: 612-262-7734• Mobile 612-810-4420 • Fax: 612-262-7643
Mail Route 10733 • 2925 Chicago Avenue • Minneapolis, MN 55407
This message contains information that is confidential and may be privileged. Unless you are the addressee (or authorized to receive for the addressee), you may not use, copy or disclose to anyone the message or any information contained in the message. If
you have received the message in error, please advise the sender by reply e-mail and delete the message.
CAUTION: This email originated from outside of the Allina Health network. Do not click links or open attachments unless you recognize the sender and know the content is safe.