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.