Medicare Advantage Plans Get Ready for 2019

Medicare Advantage Plans Get Ready for 2019

Check out our Fact Sheet for the Medicare Advantage and Part D Rate Announcement and Call Letter

In response to CMS’s release of 2019 Medicare Advantage and Part D Rate Announcement and Call LetterAdvantmed has issued its Fact Sheet, highlighting key points to help Medicare Advantage (MA) plans understand the implications and prepare for these changes.

Now is the time for MA plans to shore up their capabilities related to reimbursement, medical cost management, and risk adjustment. This is no small task, so we are lending our expertise to MA plan leaders who can benefit from our experience.


Here’s a look at some key points from the CMS Call Letter:

  • Finalizing the proposal to calculate risk scores by adding 25 percent of the risk score calculated using diagnoses from encounter data and FFS diagnoses with 75 percent of the risk score calculated with diagnoses from RAPS and FFS diagnoses.
  • Finalizing an updated HCC Risk Adjustment model that incorporates most of the proposed changes to the Part C risk adjustment model, such as adding mental health, substance use disorder, and chronic kidney disease conditions to the risk adjustment model, as well as a variety of additional technical updates.
  • +3.4 percent expected overall YOY change in revenue from Part C Methodology.
  • Expects the underlying coding trend to increase risk scores, on average, by 3.1 percent
  • Plans to begin implementing the “Payment Condition Count Model” to account for members with multiple conditions in 2020

It’s important for MA plans to put a process into place that enables them to gather and report encounter data, while quickly troubleshooting submission issues. Plans can rely on our specialized expertise because adjustments will impact plan performance, patient care, and compliance.

Our goal is to help plans integrate risk-adjustment strategies to meet growing regulatory and market demand for care quality that leads to better patient outcomes

To learn more contact or call 877.896.7350.