“Dive Brief:
CMS is planning to increase the amount of encounter data that will be used to calculate Medicare Advantage risk adjustment payments for next year to 75%, with the remainder using traditional Risk Adjustment Processing System data. That’s up from the 50/50 mix in place for this year.
The change announced in the first part of the 2021 MA advance notice Monday continues the phase-in of encounter data, which is more detailed than RAPS information. But payers say the data are less accurate and will reduce payments.
CMS said the second part of the MA advance notice will be published by early next month and both parts will be finalized by April 6. Comments on the encounter data change are due March 6.”
“Dive Insight:
MA plans receive monthly risk adjustment payments based in part on patient health status. CMS has tried to gather better information for that purpose by ramping up use of encounter data. It was first used to calculate payments in 2016 at a level of 10%.
Payers, however…” Read the full article here.
Source: CMS proposes using more encounter data for MA risk adjustment – By Shannon Muchmore, January 7, 2020. Healthcare Dive.
