Fierce Healthcare March 5, 2019
Insurers responded to CMS’ request for comment on its 2020 advance notice and draft call letter.
Medicare Advantage insurers are warning the Centers for Medicare & Medicaid Services that it should pump the brakes on its plan to expand the use of encounter data to calculate risk scores, saying such data often has gaps or errors.
CMS has used encounter data—or information about patients’ medical conditions that comes from physicians and hospitals—since 2016 to calculate risk scores in MA. But it made up just a quarter of data used in the 2019 plan year.
However, in its Advance Notice and Draft Call Letter for 2020, CMS has proposed increasing that to 50%. In their comments to the...
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