Healthcare DIVE September 15, 2020
Rebecca Pifer

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...

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Topics: CMS, Govt Agencies, Insurance, Medicare Advantage, Payer, Payment Models, Provider
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