CMS finalizes 8.5% pay rise for Medicare Advantage plans

CMS finalizes 8.5% pay rise for Medicare Advantage plans

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The Centers for Medicare and Medicaid Services announced Monday in its final rates that the Medicare Advantage plan expects an average 8.5% revenue increase in 2023 Notice for the plan.

Salary increase more than 0.5% higher than CMS Originally proposed January and follows the historical trend of increasing effective growth rates from advance notice to final filing.

Rate increases take into account additional program costs, such as COVID-19-related costs and changes in utilization.Policy experts previously Say A high inflation environment may also have contributed to this growth.

The increase was primarily due to the finalized effective growth rate of 4.88%, slightly higher than the forecasted growth rate of 4.75% in the forecast. According to the Prime Minister, this is the highest growth rate since 2009.

The agency’s final notice also includes a 3.5 percent risk score trend that hasn’t been included in rate calculations in recent years. Given the uncertainty surrounding COVID-19, CMS did not include the trend in its 2022 notice, an official said on a stakeholder call in February. The official did not elaborate on why it was not included in the calculation of changes in average earnings from previous years.

CMS also completed a 5.9% encoding mode adjustment, This is the minimum adjustment required by law. The adjustments reflect coding differences between Medicare Advantage carriers and fee-for-service Medicare providers, which have not changed since 2018. The Medicare Payments Advisory Committee and others have urged CMS to tighten adjustments to eliminate coding discrepancies. CMS risk-adjusts planned payments, so they are encouraged to develop systems to cover sicker patients, but more aggressive coding may result in higher payments.

Insurance lobbyists and programs applauded CMS’ proposal to keep the adjustment at 5.9 percent. Notes on the proposed policy.

Content Management System wrote exist This final Notice That continue its long-term existence method Yes suitable for 2023, but That it Will take Enter account Notes suggestion A sort of higher Adjustment when it promulgate rule exist Later year.

“make sure That This coding pattern Adjustment policy Appropriately address differential coding exist Well Yes basic and US will consider These suggestion exist This developing of future coding pattern Adjustment proposal” This Notice Say.

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