News: CMS updates HCC model, MA plans to average 3.4% increase in 2019
Medicare Advantage (MA) plan payment rates will increase by an average of 3.4% in 2019 due to higher projected per-capita cost growth for Medicare fee-for-service, Revenue Cycle Advisor reported. The final pay bump is significantly higher than the 1.84% increase proposed in the 2019 advance notice.
The announcement also describes changes to CMS Hierarchical Condition Categories (HCC), a risk-adjustment method which groups ICD-10-CM codes into disease categories that are related clinically and have similar cost implications. The 2019 model will add mental health, substance use disorder, and chronic kidney disease conditions, according to Revenue Cycle Advisor.
The Payment Condition Count model, a risk adjustment model proposed in the 2019 advance notice which would have adjusted for the number of conditions a beneficiary has, was not approved. CMS received a number of comments that raised concerns about how the model would be implemented and its level of complexity, Revenue Cycle Advisor reported.
CMS noted that, although the Payment Condition Count model was not approved for 2019, the agency is required by the 21st Century Cures Act to implement a model that takes into account the number of conditions a beneficiary has. CMS will begin implementing the Payment Condition Count model by 2020, according to Revenue Cycle Advisor. Stakeholders are advised to use the additional time to study the model and its implications.
Additionally, encounter data will be given more weight in risk score calculations for the 2019 revenue rates. CMS will base MA risk scores on 75% fee-for-service data and 25% encounter data in 2019. In contrast, 2018 risk scores are calculated on 85% fee-for-service data and 15% encounter data.
Editor’s note: This article originally appeared in Revenue Cycle Advisor. To learn more about HCCs and what CDI specialists should know, click here. If your CDI program has started looking at risk adjustment, consider enrolling in ACDIS’ Boot Camp on the subject.