Changes In Medicare Advantage Plans Will Help To Meet Challenges

When submitting bids to the Centers for Medicare & Medicaid Services (CMS) for the following coverage year, Medicare Advantage (MA) organizations are confronted with a grave financial forecast due to massive cutbacks in expenditures. CMS proposed legislation for its MA and Part D reimbursement systems for the 2022 contract year, potentially in response to the concern among MA.

While some of the modifications in the 2022 proposed rule had been publicized before the pandemic, several adjustments, notably to the reimbursement increase rate, were unforeseen. The top alteration in the MA and Part D final rule is risk scores and HCC Close Gaps.

Increased Rate of Effective Compensation Growth

In the rule's Advance Notice, CMS anticipated that the effective payment growth rate for 2022 would be 4.55 percent. Still, that figure soared to 5.59 percent in the final rule, amounting to a 4.08 percent revenue growth. It'sIt's an encouraging indicator for Medicare Advantage Plans since it indicates that CMS does not anticipate a substantial cost recovery following the considerable decline due to delayed or skipped treatment.

However, this does not imply that health insurance companies can be complacent. CMS contracts must be centered on more up-to-date and completely accurate Hierarchical Condition Category (HCC) information. If participants have neglected in-person treatment, such as yearly wellness checkups, for a year or longer, the likelihood of developing care gaps or chronic diseases rises.

 

Issue of HCC Close Gaps

From time to time, it has been suggested that the medicare beneficiary's beneficiary's communication and involvement activities should be intensified to fix the problem of HCC Close Gaps and detect any emerging health issues that have surfaced in the last couple of years.

Healthcare organizations can make a tremendous improvement in the HCC Close Gaps process by maintaining accurate HCC Coding, continuously reviewing the HCC performance, and detecting and focusing on areas of improvement.

The mechanism for Calculating Risk Scores

Even though payment growth will be more than predicted in 2022, this revenue gain may be mitigated for some payers in response to fluctuations in RAF score estimation. As initially reported, the RAF score will be derived entirely from data from the Encounter Data System (EDS) and fee-for-service claims in 2022, rather than a combination of interaction data and Risk Adjustment Processing System (RAPS) data.

The issue for Medicare Advantage Plans is insufficient data to establish an appropriate score. HCCs may be missed or neglected if participants skip care. Counseling participants to receive preventive services and chronic disease care can enhance score performance.