Fierce Healthcare: CMS planning to fully rely on encounter data for Medicare Advantage risk adjustment in 2022

“The Centers for Medicare & Medicaid Services said it plans to begin in 2022 using solely encounter data to calculate risk adjustment in Medicare Advantage and Part D.”

CMS released Part I of its annual Advance Notice on Monday evening, and the agency said it intends to have both parts finalized no later than April 5.”

“In the regulation, CMS said it plans to fully phase in the CMS-HCC model for risk adjustment as outlined in the 21st Century Cures Act. Harnessing that model in full means that for 2022, a plan’s risk scores would be calculated completely using encounter data, which is a controversial measure among insurers.”

“For 2021, CMS deployed a hybrid approach for risk adjustment, in which it said 75% of the data it used was encounter data.”

“The change will certainly draw ire from payers, who have repeatedly expressed concern about the quality of encounter data and the impact its use could have on their risk scores. Encounter data, or information on patient conditions that comes from physicians and hospitals, are frequently inaccurate or incomplete, insurers say…” Read the full article here.

Source: CMS planning to fully rely on encounter data for Medicare Advantage risk adjustment in 2022 – By Paige Minemyer, September 15, 2020. Fierce Healthcare.

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