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October 17, 2017
Hot Topic
As CMS collects more encounter data, CMS is working to improve the accuracy of the data, which is used to adjust risk scores that drive payments to Medicare Advantage plans.
As the volume of encounter data collected by CMS grows — reaching an anticipated 775 million records for 2017 — the agency is working to ensure that data are accurate and complete...
CMS has gotten a lot of heat this year from insurers on its use of less-than-perfect Medicare Advantage encounter data in determining risk scores — resulting in the agency slowing down its planned transition to 100% use of encounter data by 2020...
As expected, the final 2018 payment notice and Call Letter for Medicare Advantage and Part D plans contained no drastic alterations to the MA program and few deviations from policies proposed 60 days earlier in the Advance Notice...
Quest Diagnostics

Today's AIS Health Datapoint
$197.10 ... is highest monthly drug premium offered by 2018 Medicare Part D stand-alone prescription drug plans (PDPs). The premium is offered by Blue Cross and Blue Shield of Texas's Blue Cross MedicareRx Plus PDP and has a $0 annual drug deductible.

Quote of the Day
“Interventions that work very well for commercial populations may also work for Medicare populations, but there may be other interventions that are even more effective. Health plans should seek the best option, even if it is different than the best option for commercial patients.”
— David Muhlestein, chief research officer at Leavitt Partners, tells AIS Health that expanding a medical home from commercial to Medicare patients may require insurers to adjust some interventions.

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