Medicare Advantage plan payment rates will increase by an average of 3.4% in 2019. the final pay bump is significantly higher than the 1.84% increase proposed in the 2019 Advance Notice. This increase was due to the improvement in the encounter diagnosis data quality. The CMS 2019 proposed expansion of the Hierarchical Condition Category (HCC) methodology has been delayed until 2020 and included a Payment Condition Count model. The Payment Condition Count model expands the methodology and considers the total number of conditions * a beneficiary has when calculating the risk score. The 21st Century Cures Act requires an enhancement to the current HCC methodology. As such, the Payment Condition Count model will begin implementation in 2020, significantly increasing the financial risk associated with documentation, coding and HCC capture outcomes.
