CMS has used Medicare Advantage diagnoses submitted into its Risk Adjustment Processing System, as well as encounter data from Medicare Advantage organizations, to calculate risk scores for these plans, according to the agency. CMS originally proposed keeping the blend of 75 percent of RAPS-based risk scores and 25 percent of encounter data-based risk scores for payment. However, CMS revealed Monday in its 2018 Rate Announcement and Call Letter it has decided after reviewing comments to use a risk score blend of 85 percent RAPS scores and 15 percent encounter data scores in 2018.
“It is important that any risk adjustment in Medicare Advantage is fair and accurate,” Chet Speed, AMGA’s vice president of public policy, said in a news release. “With the flaws in the current encounter data system, CMS made the right choice in dropping the weight to 15 percent.”
AMGA also addressed coding. “CMS also is implementing the minimum coding intensity adjustment as required by law,” the group said. “This adjustment is intended to account for differences in diagnosis coding between Medicare Advantage and fee-for-service. For example, [the Medicare Payment Advisory Commission] has suggested using two-years’ worth of diagnostic data to calculate risk scores, a suggestion CMS should consider.”
Mr. Speed added: “This is a problem that Congress can address with help from the stakeholder community. This year-to-year variation isn’t helpful, and a more equitable system should be explored.”
Read the full AMGA release here.
More articles on healthcare finance:
Arizona hospital falls into bankruptcy less than 2 years after opening
Key West commissioner: CHS hospital’s profit margin is ‘obscene and unconscionable’
SSM Health’s operating income tumbles after St. Louis hospital acquisition
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.