CMS gives Medicare Advantage plans a raise

The CMS finalized a rule Monday giving Medicare Advantage plans a 3.4% pay hike in 2019. That’s well above the 1.84% bump the agency initially proposed and higher that the 2.95% increase for 2018.

The CMS is also moving forward with plans to increase the use of encounter data to determine risk scores for plans. As a result of the finalized rule, 75% of Medicare Advantage risk scores will be based on traditional fee-for-service data, and 25% based on encounter data. That differs from 2018, when the agency used a risk score blend of 85% fee-for-service data and 15% encounter data.

Stakeholders such as the American Hospital Association have pushed back at using encounter...