2022 Medicare Advantage Advance Notice Changes Process for Risk Adjustment Scores

2022 Medicare Advantage Advance Notice Changes Process for Risk Adjustment Scores

CMS has released Part 1 of the 2022 Medicare Advantage Advance Notice, which reviews the updates to the Part C CMS-HCC risk adjustment model and the application of encounter data (CMS, 2020). In addition, the agency scheduled the changes to the CMS Advance Notice be finalized by April 5, 2021.

Here are the main changes the notice discusses:

CMS will fully enact the 2020 CMS-HCC risk adjustment model in 2022. The new Medicare notice proposal outlines how CMS plans to calculate the entire risk score using the 2020 CMS-HCC model (CMS, 2020). This is different from the 2021 notice. The 2021 notice calculates risk scores by 75 percent using the 2020 CMS-HCC model. The remaining 25 percent uses the 2017 CMS-HCC model.

Medicare Advantage diagnoses will solely rely on encounter data. Furthermore, risk scores will no longer use a mix of encounter data and Risk Adjustment Processing System (RAPS) data. After CMS fully phases-in the 2020 CMS-HCC model, risk scores will use diagnoses from encounter data submissions to calculate Part C risk scores (CMS, 2020). In addition, the policy of supporting encounter data diagnoses with RAPS inpatient records diagnoses for beneficiary risk scores will be discontinued.

CMS released Part 1 of the 2022 Medicare Advance Notice earlier than scheduled. This is to give Part D sponsors and Medicare Advantage organizations enough time to account for the changes when preparing their 2022 bids. Review the CMS fact sheet for more information (CMS, 2020).

Further Information

Additionally, HCC coding and risk adjustments are one of YES HIM Consulting’s many specialties. Furthermore, the Risk Adjustment & HCC Basics learning path from YES HIM Education provides an overview of the HHS and CMS risk adjustment models, documentation, coding practices, and much more.

You can also review these additional articles about HCC coding, risk adjustment models, Medicare Advantage, and more, authored by our team of HIM experts:

Karen Youmans

Karen G. Youmans, MPA, RHIA, CCS – President, YES HIM Consulting, Inc. AHIMA-approved ICD-10-CM/PCS trainer
CMS advance notice

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