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Medicare Advantage CMS Star Rating Program Support

Advent helps you chart a sustainable course to reach a CMS 5-Star rating that will help you grow your business.

Promoting continuous Star rating improvements

The Centers for Medicare and Medicaid Services (CMS) Medicare Star Rating program promotes continuous quality improvement and recognizes and rewards healthcare organizations for demonstrating an increase in performance measures over time.  The highest rating in the CMS Star program is a five.

With an in-depth knowledge of CMS requirements and 12 NCQA-certified HEDIS auditors on staff, Advent’s team of experts can help your organization:

  • Identify and improve HEDIS® and MDV performance measures that are most likely to impact overall CMS Star ratings
  • Discover the root causes of underperformance and develop corrective strategies
  • Develop a sustainable plan to drive continuous improvement in care quality, increase star ratings and earn greater quality bonus payments

Your Star rating not only impacts quality bonus payments, but also membership enrollment as the percentage of Medicare Advantage beneficiaries enrolled in high-performing plans continues to increase. According to the CMS, “the percentage of Medicare Advantage enrollees in four or five Star rated plans has almost quadrupled since 2009 to 71 percent. About one-third of prescription drug plan enrollees are in standalone Part D plans with four or more stars, compared to 27 percent of enrollees in such plans in 2009.”

Contact Advent Advisory Group today and find out how we can help you achieve higher CMS Star ratings and compete more effectively in today’s quickly changing healthcare landscape.

Prescription Drug Event (PDE) Services

Advent Advisory Group provides review, analysis, and validation services of pharmacy data, including Prescription Drug Event (PDE) data.  MA-PDs and PDPs submit paid Rx claims data to CMS via the standardized PDE file layouts.  This data is used by CMS to reimburse plans, determine cost sharing amounts, and identify plans requiring a CMS audit.  Errors in this data could result in CMS denying payment for future claims and/or revoking payment for previously-paid claims.  The PDE data is also used to calculate five CMS STARS measures.

Should your organization be interested in having Advent work with you to assess the accuracy and completeness of your PDE data submissions, please contact us at:  info@adventadvisorygroup.com.