For 2022, the Centers for Medicare and Medicaid Providers is proposing to  use only encounter info in calculating chance adjustment utilised to pay back Medicare Benefit strategies.

The Section C chance rating would depend totally on encounter info as the source of MA diagnoses, CMS said in releasing Section I of the 2022 Medicare Benefit Progress Detect.
This represents a modify from the blend for 2021 of seventy five{312eb768b2a7ccb699e02fa64aff7eccd2b9f51f6a579147b7ed58dbcded82a2} of the chance rating calculated utilizing the 2020 CMS-HCC design and 25{312eb768b2a7ccb699e02fa64aff7eccd2b9f51f6a579147b7ed58dbcded82a2} of the chance rating calculated utilizing the more mature 2017 CMS-HCC design.

WHY THIS Issues

The modify is expected by the twenty first Century Cures Act. 

CMS calculates chance scores utilizing diagnoses submitted by MA companies and from Medicare payment-for-services statements. 

Traditionally, CMS has utilised diagnoses submitted into CMS’ Risk Adjustment Processing Method (RAPS) by MA companies for the reason of calculating chance scores for payment. 

In recent yrs, CMS began accumulating encounter info from MA companies, which also contains diagnostic data. CMS began utilizing diagnoses from encounter info to calculate chance scores for CY 2015, and has since continued to use a blend of encounter and RAPS info-dependent scores.

Also, for CY 2022, CMS is proposing to discontinue the policy of supplementing diagnoses from encounter info with diagnoses from inpatient information submitted to RAPS for calculating beneficiary chance scores.

THE Larger sized Pattern

This announcement of Medicare Benefit and Section D payment methodologies is getting made somewhere around three months before than common to offer Medicare Benefit companies and Section D sponsors additional time to take this data into thought as they get ready their bids for 2022.

The before launch will support Medicare Benefit and Section D strategies to much better tackle estimating 2022 strategy prices, in mild of the uncertainty linked with the COVID-19 pandemic.

The Progress Detect Section I contains data about Medicare Benefit chance adjustment for 2022 with a sixty-day comment period of time. Other alterations to payment methodologies for 2022 that are generally contained in the Progress Detect Section II only call for a 30-day comment period of time and will be produced at a later time. 

The Medicare Benefit and Section D payment policies for 2022, talked about in each Section I and Section II of the Progress Detect, will be finalized in the 2022 Level Announcement revealed no later than April 5, 2021.

Twitter: @SusanJMorse
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