5 Things to Know about Medicare Drug Coverage Plans

ONTARIO, Calif. - March 5, 2021 - PRLog -- CMS (Centers for Medicare and Medicaid Services) recently released rates for Medicare Drug Coverage Plans. It came on air five months before their original date to encourage stakeholders to select bids for 2022. Moreover, it is a great step towards efficient QPP MIPS reporting.

Here are five things to remember for the Medicare Advantage Part D coverage to place reasonable bids for Medicare plans.

High Rates of Per-Plan Capita

According to the survey, CMS estimates that per-capita payment plans will rise by 4.08% on average. It will impact the expenses incurred during the rendering of quality services. Also, the cost performance category in QPP MIPS will be influenced significantly.

Introduction of New Risk Model

CMS also said to introduce a new risk model by introducing phasing in the existing payment framework. It will include variables for multiple medical conditions all at once. For Instance, to document a patient having a medical condition, a mental condition, drug abuse, and chronic kidney disease. The outcomes of the QPP MIPS reporting in the Quality category might undergo some changes with this rule.

Medicare Part C Risk Score

For the year 2022, CMS decided to rely solely on data for Medicare Advantage encounters and fee-for-service claims to diagnose Medicare Part C risk payments.
Coding Pattern Adjustment

CMS also proposed a rule where they are applying a coding pattern adjustment of 5.90 percent, which is the minimum performance threshold. Moreover, they finalized the date (June 30) to appeal for the changes, complaints, and measure data 2022.

Review Period

The date for final bids is due by June 7. However, CMS released these guidelines before the expected period so that Medicare reviews the health and drug prescription plan to finalize their bids before the bidding starts.

The modifications are a great step to empower the medical billing and coding process, keeping the reimbursement rate in check for clinicians. Consult our resources to know details about the billing updates.

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