CMS proposes using only encounter data for Medicare Advantage risk adjustment and payment

Healthcare Finance News September 15, 2020
Susan Morse

The proposal is being released early for plans to better address estimating 2022 costs, in light of the uncertainty with the COVID-19 pandemic.

For 2022, the Centers for Medicare and Medicaid Services is proposing to use only encounter data in calculating risk adjustment used to pay Medicare Advantage plans.

The Part C risk score would rely entirely on encounter data as the source of MA diagnoses, CMS said in releasing Part I of the 2022 Medicare Advantage Advance Notice.

This represents a change from the blend for 2021 of 75% of the risk score calculated using the 2020 CMS-HCC model and 25% of the risk score calculated using the older 2017 CMS-HCC model.

WHY THIS MATTERS

The change is required...

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