CMS Signals Complete Phase-In of EDPS-Based Payments in 2022

Dynamic Healthcare Systems is prepared to help Medicare Advantage plans to transition to full EDPS submittals while preserving the ability to respond to prior years’ RAPS rejects and deletes.

Santa Ana, CA, December 16, 2020 --( In September 2020, the Centers for Medicare & Medicaid Services (CMS) released an Advance Notice proposing that effective Calendar Year (CY) 2022, all risk-adjusted payments to Medicare Advantage (MA) plans will be based on 837 Encounter Data System (EDS) data, finally retiring the older Risk Adjustment Processing System (RAPS). MA plans need to take action now to prepare for the more complex 837 data submissions, as well as the multiple steps necessary to submit data or resubmit rejected submissions.

Dynamic Healthcare Systems, a leading provider of comprehensive software solutions to health plans and health systems participating in Medicare Advantage, Managed Medicaid, and Marketplace programs, is poised to help clients through the final transition to EDS, predict and protect risk-based revenue, and maintain compliance with Medicare Advantage Capitation Rates and Part C and Part D Payment Policies.

If the proposed methodological changes are enacted, RAPS will be eliminated starting in 2022; however, MA plans will still need to have RAPS processing available for reconciliation, resubmission, and deletes of prior years’ data. As the rules apply today, CMS requires plans to send deletes as far back as seven years if plans discover overpayments on members, potentially necessitating the ad-hoc submission of RAPS deletes until 2029.

“Plan revenue will be impacted if plans either fail to act or use tools that are not reflective of all the CMS logic,” said Jim Corbett, Chief Strategy Officer at Dynamic Healthcare Systems. “Dynamic’s risk adjustment solutions are designed to ensure that plans can continue processing EDS data while adhering to the correction and deletion requirements of RAPS submissions,” added Mr. Corbett.

Managing rejected encounters and using risk adjustment-oriented tools is vital to protecting health plan revenue. Dynamic employs a system based on audit oversight, reconciliation between RAPS and EDS, and Analytical tools, containing the entirety of CMS’s logic and requirements built directly into it. Dynamic’s system incorporates these CMS changes and turns them into digestible, clearly understandable reports that spell out the bottom-line impacts.

Dynamic’s robust Medicare Advantage suite of integrated solutions provides health plans and provider groups with an enterprise-wide platform that enables a strong risk adjustment strategy ensuring maximum and accurate risk-adjusted payments. Dynamic’s integrated software solutions are designed to ensure health plans and provider groups meet the complex compliance and data processing requirements that the CMS establishes, monitors, and enforces. Dynamic’s solutions integrate various sources of health plan and provider data to create a single view of a Plan’s membership. This single view facilitates the delivery of high-quality managed care while helping health plans meet compliance and revenue management challenges.
Dynamic Healthcare Systems
Denise Uselding
949-333-4565 ext. 180