US Centers for Medicare and Medicaid Services raises Medicare Advantage payments 2.48% for 2027
Change
US Centers for Medicare and Medicaid Services (CMS) finalised a rule that increases Medicare Advantage plan payments by a net average of 2.48% for 2027—adding more than $13 billion—and removes diagnoses derived from unlinked chart reviews from risk-score calculations except when a beneficiary moves between Medicare Advantage organisations.
Why it matters
Organisations that rely on diagnoses submitted from unlinked chart reviews will no longer be able to count those entries toward risk-adjusted payments, reducing revenue unless documentation is linked to specific patient encounters. Risk-adjustment and medical-record workflows must be changed to tie diagnoses to encounters or plans will face lower risk scores and corresponding payment reductions.
Implications
- • Medicare Advantage plan finance teams must update 2027 revenue forecasts and premium-setting models to reflect the 2.48% net payment increase, or risk underestimating available funding.
- • Medicare Advantage risk-adjustment teams must stop relying on unlinked chart review submissions and reconfigure risk-scoring and documentation workflows to ensure diagnoses are linked to specific patient encounters, or their organisations will see lower risk scores and reduced payments.
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