From Modern Healthcare — 01/06/2020:

CMS wants to use more encounter data for Medicare Advantage payments

  • The CMS proposed changes to Medicare Advantage payments for 2021, including an increase in the percentage of patient encounter data used to calculate payments.

  • The agency said it plans to continue phasing in the use of diagnoses from encounter data to determine patient risk scores, which are used to adjust insurer payments from the federal government.

  • The CMS has used encounter data to calculate payments since 2016, but wants to use more of it. For 2021, it proposed using a blend of 75% encounter data and 25% of data from the less-detailed Risk Adjustment Processing System (RAPS) — which historically was used to calculate risk scores.

  • In 2020, the CMS is using a mix of 50% encounter data and 50% RAPS.

To read the full article, click here.

Key Takeaway

Encounter Data Submission & Processing (EDPS) is the now and the future. If your health plan is not currently ready for the 50/50 EPDS/RAPS blend in 2020 or next year’s 75/25 EDPS/RAPS data submission requirement, now is the time to get things in order. With Babel Health’s expertise, system and processes, making the switch is streamlined. We focus on accurate, complete and compliant encounter submissions.