CMS finalizes 2021 Medicare Advantage rates: 5 things to know

CMS finalized updates to the methodologies it uses to pay Medicare Advantage organizations, Program of All-Inclusive Care for the Elderly programs and Medicare Part D prescription drug plans.

Five things to know:

1. Medicare Advantage, PACE and Part D organizations will get a 1.66 percent payment boost in 2021.

2. CMS finalized how it will calculate risk scores for 2021 payments to Medicare Advantage organizations. Risk scores will be the sum of 75 percent of the risk score calculated with the 2020 CMS-Hierarchical Condition Categories model and 25 percent of the risk score calculated with the 2017 version of the model. The scores used to be the sum of 50 percent of both models.

3. CMS also finalized how it will use encounter data, or diagnostic information, in the risk adjustment calculation process. CMS will calculate risk scores for payment to Medicare Advantage organizations as the sum of 75 percent of the encounter data-based risk score and 25 percent of the Risk Adjustment Processing System-based risk score.

4. For 2021, CMS will apply a coding pattern adjustment of 5.9 percent — the minimum adjustment for coding intensity required.

5. CMS will also exclude kidney organ acquisition costs from Medicare Advantage benchmarks. The change is effective Jan. 1, 2021.

For the full final rule, click here.

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Humana to expedite claim processing, suspend more prior authorization rules

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