CMS proposes using only encounter data for Medicare Advantage risk adjustment and payment

Elvera Bartels

For 2022, the Facilities for Medicare and Medicaid Providers is proposing to  use only come upon details in calculating threat adjustment utilised to pay Medicare Gain strategies.

The Section C threat score would count completely on come upon details as the supply of MA diagnoses, CMS claimed in releasing Section I of the 2022 Medicare Gain Advance Observe.
This signifies a transform from the blend for 2021 of seventy five% of the threat score calculated employing the 2020 CMS-HCC design and 25% of the threat score calculated employing the more mature 2017 CMS-HCC design.

WHY THIS Issues

The transform is demanded by the twenty first Century Cures Act. 

CMS calculates threat scores employing diagnoses submitted by MA organizations and from Medicare rate-for-provider promises. 

Historically, CMS has utilised diagnoses submitted into CMS’ Danger Adjustment Processing Procedure (RAPS) by MA organizations for the goal of calculating threat scores for payment. 

In modern

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