November 5, 2020

The Impact of COVID-19 on Medicare Advantage Risk Scores and Payment

This analysis, conducted by Avalere Health and commissioned by Better Medicare Alliance, considers how reductions in service utilization as a result of the COVID-19 pandemic may lead to insufficient data to accurately determine 2021 Medicare Advantage risk scores and payment.

The report examined Medicare Advantage claims data through June 2020 and found that total Medicare Advantage claims dropped 66% in April 2020 from 2019 and remained 61% lower in May and June as compared to the same months a year earlier.

Lower utilization results in fewer opportunities for providers to code diagnoses. The Centers for Medicare & Medicaid Services (CMS) uses diagnosis data from claims to calculate Medicare Advantage risk scores used to adjust payments to Medicare Advantage plans.


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