Why payers are fretting over a proposed CMS rule: 7 things to know

Becker's Healthcare January 27, 2023
Rylee Wilson

A proposed rule change coming from CMS is making payers nervous.

CMS is expected to issue its final rule on risk adjustment data valuation, and the change could have a big impact on Medicare Advantage plans. In 2018, the agency proposed eliminating the fee-for-service adjuster, which allows for a permissible number of payment errors in audits.

Here’s seven things to know about the proposed rule:

1. The rule was first proposed in 2018. The agency has proposed applying this adjustment retroactively, meaning payers could be on the hook for up to $3 billion in repayments.
2. Industry leaders have been critical of the rule. AHIP President Matt Eyles told Becker’s the rule is “unlawful in terms of...

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