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The AAHAM Legislative Currents are hosted here.  In order to read them, you will need to be logged in.

Tuesday, January 7, 2020

CMS May Put Providers Over Insurers in Calculating Medicare Advantage Risk Adjustment

CMS wants to give health provider assessments of patients' conditions more weight than private Medicare plans' own reports when deciding how much financial assistance is owed to insurers with sicker customers.

The proposal, released on Monday as part of a notice of possible Medicare payment changes for 2021, involves the higher rates that Medicare Advantage plans get from the government if they can show their enrollees have a chronic or serious illnesses. Starting in 2021, patient data from provider visits would account for 75 percent of the "risk score" assigned to the plans, compared with the current 50 percent. That would presumably cut at least some of their payments. 

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