CMS releases second part of Medicare Advantage, Part D rule: 3 things to know

CMS issued part two of its proposed 2022 Medicare Advantage Advance Notice, which updates payment methodologies to Medicare Advantage and Part D plans.

Three things to know: 

1. CMS plans to increase payment rates to Medicare Advantage plans by 2.82 percent compared to last year.

2. CMS wants to apply a coding pattern adjustment of 5.9 percent to reflect differences in diagnosis coding between Medicare Advantage plans and fee-for-service providers. The adjustment is the minimum for coding pattern differences required by law.

3. As outlined in part one of the proposed rule, risk scores used to calculate payment to Medicare Advantage plans in 2022 would rely entirely on encounter data as the source of diagnoses. In the past, CMS has used a blend of encounter data and diagnoses submitted to its risk adjustment processing system.

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