Healthcare DIVE September 15, 2020
Dive Brief:
- CMS is proposing calculating risk scores in Medicare Advantage plans using diagnoses solely from encounter data for 2022. Monday’s announcement marks the end of a multiyear transition plan that should skew positive for MA companies.
- Since 2015, the agency has calculated risk scores using a blend of provider-generated encounter data on patients’s conditions and treatment needs and diagnoses from inpatient records submitted by MA plans.
- The agency expects the proposed changes will result in a 0.25% rise in MA risk scores in 2022 compared to 2021, or a net cost to the Medicare program of almost $634 million.
Dive Insight:
Insurers have generally pushed back against using encounter information to adjust payments, arguing it’s often incomplete...