Calendar Year 2023 Medicare Advantage and Part C & D Payment Policies

August 9th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Categories:   Medicare Advantage  
0 Votes - Sign in to vote or comment.

On April 4, 2022, CMS finalized the 2023 MA capitation rates, as well as the Part C and Part D payment policies, in this publication: CMS CY 2023 Rate Announcement. As is standard for each annual update, the CY 2023 Capitation Rate Tables are available for review and download on the CMS Ratebooks and Supporting Data website.

In the Calendar Year 2023 Advance Notice, CMS described plans for a more focused approach to advancing health equity through the collection and analysis of data such as race, ethnicity, and social determinants of health. CMS plans to focus on the development of quality reporting measures, enhanced methodologies for measuring and addressing health disparities, and using all of these to drive value in healthcare. Focus will also include ensuring every dollar spent is focused on addressing programmatic changes in an effort to close health equity gaps. One thing CMS noted was that all commenters on the rule expressed a common support for the promotion of health equity. 

As part of the goal to advance initiatives to close the gap on health disparities, CMS requested input on the following specific topics: 

How to improve the Medicare Advantage and Part D Star Ratings 
How to incorporate factors related to health equity and social determinants of health into risk adjustment models
Considerations when assessing the geographic level of rate setting for ESRD beneficiaries and its potential implications for health equity

Included in the Rate Announcement are eight attachments that address the following: 

  1. Final estimates of the following are used to calculate the CY 2023 capitation rates:
    • National Per Capita MA Growth Percentage for CY 2023
    • National Medicare Fee-for-Service (FFS) Growth Percentage for CY 2023
    • National Per Capita Medicare Advantage (MA) Growth Percentage for CY 2023
    • National Medicare Fee-for-Service (FFS) Growth Percentage for CY 2023
  2. Key assumptions and financial information behind growth percentages
  3. CMS responses to Part C payment-related comments from the 2023 Advance Notice
  4. CMS responses to Part D payment-related comments from the 2023 Advance Notice
  5. Part D benefit parameters, including the details of how they are updated
  6. CMS responses to comments on updates for MA and Part D Star Ratings
  7. Economic information related to the CY 2023 Rate Announcement
  8. Relative factors for the following two risk adjustment models:
    • 2023 CMS-HCC ESRD
    • 2023 RxHCC 

The Rate Announcement also includes key updates such as growth percentages for both Medicare Advantage and Medicare Fee-For-Service (FFS) programs as well as the calculation of FFS costs. Policies that are published in the Advance Notice, but are not modified or retracted in the Rate Announcement, take effect in the upcoming calendar year. Any clarifications made in the final Rate Announcement will supercede those that were published in the Advance Notice. A complete listing of the policies to be adopted in CY 2023 are listed in the Rate Announcement as well. If you spent time in the Advance Notice, it is time to dig into the Rate Announcement to see what has become finalized for CY 2023. 



Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.

Latest articles:  (any category)

Medicare Updates -- SNF, Neurostimulators, Ambulance Fee Schedule and more (2022-10-20)
October 27th, 2022 - CMS - MLNConnects
Skilled Nursing Facility Provider Preview Reports: Review by November 14 - Help Your Patients Make Informed Health Care Decisions - Ambulance Fee Schedule: CY 2023 Ambulance Inflation Factor & Productivity Adjustment - Compliance - Implanted Spinal Neurostimulators: Document Medical Records - Claims, Pricers, & Codes...
2023 Evaluation & Management Updates Free Webinar
October 24th, 2022 - Aimee Wilcox
Congratulations on a successful 2021 implementation of the Evaluation and Management (E/M) changes! That was a big change, but now an even bigger change is headed your way for inpatient and all other E/M categories. How great is it that almost all of the E/M categories will now be scored based on medical decision making (MDM) or total provider time? Standardized scoring and one set of E/M guidelines has the potential of bringing about a change or improvement of provider fatigue due to over regulation and documentation burden.
Are Leading Queries Prohibited by Law or Lore?
October 13th, 2022 - Erica E. Remer
AHIMA released its CDI Practice Brief Monday. At Yom Kippur services, I found myself thinking about the question Dr. Ronald Hirsch posed to me the day before. My rabbi was talking in her sermon about the difference between halacha and minhag. Halacha is law; it is the prescriptions...
2023 ICD-10-CM Guideline Changes
October 13th, 2022 - Chris Woolstenhulme
View the ICD-10-CM Guideline Changes for 2023 Chapter 19 (Injury, poisoning, and certain other consequences of external causes [S00-T88])The guidelines clarify that coders do not need to see a change in the patient’s condition to assign an underdosing code. According to the updated guidelines, “Documentation that the patient is taking less ...
Z Codes: Understanding Palliative Care and Related Z Codes
October 11th, 2022 - Gloryanne Bryant
Palliative care is often considered to be hospice and comfort care. Palliative care is sometimes used interchangeably with “comfort care” and then again sometimes with “hospice care.”  But these terms do have slightly different meanings and sometimes the meaning varies depending on who is stating it. The National...
2023 ICD-10-CM Code Changes
October 6th, 2022 - Christine Woolstenhulme, CPC, CMRS, QCC, QMCS
In 2022 there were 159 new codes; the 2023 ICD-10-CM code update includes 1,176 new, 28 revised, and 287 deleted codes, a substantial change from last year. The 2023 ICD-10-CM codes are to be used for discharges from October 1, 2022 through September 30, 2023, and for patient encounters from ...
Yes, You Have What It Takes To Lead Your Practice And Your Profession
September 20th, 2022 - Kem Tolliver
If you’ve been in any healthcare role for more than two years, you’ve seen quite a bit of change. And guess what, it’s not over. We are living and working in uncertain times. This climate requires each of us to step outside of our comfort zones to lead exactly where we stand. It’s not required of one to have a “title” to lead. What is required, however, is a willingness to trust your instincts, look for answers and rely on your team.

Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2022 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association