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April 27, 2017

Recent Stories

From Medicare Advantage News - As expected, the final 2018 payment notice and Call Letter for Medicare Advantage and Part D plans posted April 3 contained no drastic alterations to the MA program and few deviations from policies proposed 60 days earlier in the Advance Notice. But one significant change that gave MA plans a bit of relief was a partial retreat on the percent of encounter data used in risk scores, although industry experts are quick to remind plan sponsors that encounter data aren’t going away and that CMS will continue its efforts to make sure plans are submitting accurate data. Read more

Medicare Advantage plan sponsors that were hoping to get a little relief… Read more

Now that the GOP has withdrawn the American Health Care Act (AHCA)… Read more

After unveiling its intent to intervene in a five-year-old qui tam lawsuit… Read more

From the Editor

Welcome to your Medicare Advantage News subscriber-only Web page

Be sure to visit often, for PDFs of issues, archives of articles, links to government documents and more!

Please e-mail me with your comments on the last issue of Medicare Advantage News, story ideas for future issues, or any other suggestions you have that can make the newsletter more useful for you.

April 3, 2017
2018 Final Rate Notice Includes Revision to EDS Use, RFI on Potential Innovations

While the 2018 Final Payment Notice and Call Letter for Medicare Advantage and Part D plans posted on April 3 carried over many of the same policies from the preliminary notice issued in February, one notable revision made by CMS pertained to its use of encounter data in calculating risk scores. In response to "extensive" feedback from plans about the payment impact associated with the ongoing transition to the encounter data system (EDS), CMS scaled back its earlier proposal of using a blend of 75% risk adjustment payment system (RAPS) data and 25% EDS data to a mix of 85% RAPS and 15% EDS.

The final notice also indicated that plans will see a slightly better improvement in reimbursement of 0.45% when compared with the modest pay hike of 0.25% included in the Advance Notice published two months ago. Factoring in an expected diagnosis coding trend of 2.5% and a rebasing adjustment of 0.3% that CMS did not include in its preliminary projections, CMS estimated that plans could see their payments improve by 2.95% on average, compared with its earlier estimate of 2.75%.

Moreover, CMS for the first time used the notice to make a request for information soliciting ideas from the public on ways CMS can bring more transparency, flexibility, program simplification and innovation to the MA and Part D programs that could be incorporated into future regulatory, subregulatory, policy, practice and procedural changes from the agency. CMS officials during a Feb. 3 press call indicated this request is a reflection of the new administration's "openness" to innovation in the MA space.

View the final rate notice and RFI here.

March 22, 2017
Bonus Insight Reports for Subscribers

Several special reports covering key issues of concern to today’s health care executives are now available in your Subscriber Library. These original reports from the AIS Health editorial team are filled with practical strategies for managing Medicare patients’ pharmacy and medical costs. Access them at

February 17, 2017
Justice Dept. Joins Whistleblower Lawsuit Alleging MA Upcoding by UnitedHealth Group, Affiliates

Justice Dept. joins whistleblower lawsuit alleging MA upcoding by UnitedHealth Group and affiliates.

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