SANTA ANA, Calif.--(BUSINESS WIRE)--Responding to the recent release of the 2019 Medicare Advantage and Part D Rate Announcement and Call Letter, Advantmed, LLC, an integrated risk-adjustment optimization and quality improvement company, announces the release of its Fact Sheet, highlighting key points to help Medicare Advantage (MA) plans understand the implications and prepare for these changes.
“MA plan capabilities related to reimbursement, medical cost management and risk adjustment must be responsive to CMS changes,” says Jay Baker, senior vice president, quality and risk adjustment solutions. “Advantmed recognizes that this is not always a simple undertaking and will lend its expertise to MA plan leaders who can benefit from our experience.”
Highlights from the CMS Call Letter:
- Finalizing the proposal to calculate risk scores by adding 25 percent of the risk score calculated using diagnoses from encounter data and FFS diagnoses with 75 percent of the risk score calculated with diagnoses from RAPS and FFS diagnoses.
- Finalizing an updated HCC Risk Adjustment model that incorporates most of the proposed changes to the Part C risk adjustment model, such as adding mental health, substance use disorder, and chronic kidney disease conditions to the risk adjustment model, as well as a variety of additional technical updates.
- +3.4 percent expected overall YOY change in revenue from Part C Methodology
- Expects the underlying coding trend to increase risk scores, on average, by 3.1 percent
- Plans to begin implementing the “Payment Condition Count Model” to account for members with multiple conditions in 2020
“A process should be in place to gather and report encounter data, while quickly troubleshooting submission issues,” Baker adds. “Adjusting to these changes will require specialized expertise because adjustments will impact plan performance, patient care and compliance. Successful health plans and provider-sponsored organizations must integrate risk-adjustment strategies to meet growing regulatory and market demand for care quality that leads to better patient outcomes.”
About Advantmed, LLC
Advantmed, LLC is a healthcare solutions company dedicated to partnering with health plans, provider groups and risk-bearing entities to optimize risk adjustment and quality improvement programs. Our integrated and technology-enabled solutions improve health plan financial results and offer insights on health plan members. For more information on Advantmed’s solutions visit www.advantmed.com.