SOA Podcasts - Society of Actuaries

Health Section - Medicare Advantage Risk Scores: Transition to encounter data


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The Medicare Advantage market is currently in the middle of a multi-year transition from the existing Risk Adjustment Processing System (RAPS) to the new Encounter Data System (EDS) for calculating risk scores. CMS has stated that ultimately EDS will be the sole diagnosis data source for Medicare Advantage organizations’ risk scores and revenue. Dave Dillon, FSA, MAAA, interviews Deana Bell, FSA, MAAA, on the topic and they discuss how the transition has shown to have a financial impact on Medicare Advantage revenue and how actuaries are well equipped to help.

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SOA Podcasts - Society of ActuariesBy Society of Actuaries (SOA)

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