Government Healthcare Policy, Business and Technology

New Medicare Advantage payment methodology could take hold in 2022

Modern Healthcare: CMS on Monday pitched changes to Medicare Advantage payments for 2022 that would complete a multiyear phase-in of a new payment methodology in which plan payments are adjusted using diagnoses solely from encounter data, which is information created by healthcare providers about patients' medical conditions and treatment.

In 2022, the agency wants to fully transition to a risk adjustment model first adopted for 2020, as required by the 21st Century Cures Act. The model, called the CMS-Hierarchical Condition Categories model, adds variables that count conditions in the risk-adjustment model and includes for payment additional conditions for mental health, substance use disorder and chronic kidney disease.

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