AMGA praises CMS' limit on Medicare Advantage encounter data

AMGA said it is pleased with a recent CMS decision regarding risk scores for Medicare Advantage plans.

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.


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