Beacon Alert 2025-011 Weekly Regulatory Updates
As healthcare organizations prepare for Contract Year 2026, CMS is ramping up its focus on encounter data quality, an essential component of Medicare Advantage (MA) risk adjustment and payment accuracy. In the week of March 10, 2025, the Centers for Medicare & Medicaid Services (CMS) released its latest performance monitoring update—a critical tool for MAOs aiming to enhance compliance and operational precision.
Purpose of the Encounter Data Submission Performance Report
The Medicare Advantage Encounter Data Submission Performance Report is part of CMS’s ongoing effort to promote data transparency and submission accuracy among Medicare Advantage Organizations (MAOs). These reports help plans assess whether their submitted encounter data meets the thresholds and completeness required for CMS calculations and audits.
- Who It’s For: All Medicare Advantage Organizations (MAOs)
- Objective: To identify data submission deficiencies and guide improvement efforts with technical feedback and support from CMS
These reports are particularly useful in spotting gaps in critical claims and encounter data that could impact risk adjustment payments and overall plan performance ratings.
Accessing the Q4 2024 Submission Reports
The Quarter 4 2024 Submission Performance Reports are now available on the Health Plan Management System (HPMS). Here’s how to access them:
- Navigation Path in HPMS:
HPMS Home Page > Risk Adjustment > Encounter Data > Submission Performance > 2025 February Update
This centralized portal allows compliance officers, data teams, and risk adjustment leads to compare submission benchmarks and initiate corrective action where needed.
A Brief History of the Report Program
CMS began releasing these Encounter Data Submission Performance Reports in 2019 as part of a broader push toward risk adjustment data integrity. Over the years, these reports have become integral to plan operations, providing both benchmarking tools and technical remediation strategies.
Why This Matters for MAOs
Accurate and timely encounter data is essential for:
- Ensuring correct plan reimbursement through risk-adjusted payments
- Supporting compliance audits and oversight by CMS
- Maintaining strong performance in CMS Star Ratings, which directly impact bonus payments and member enrollment
MAOs that underperform in encounter data submissions risk payment inaccuracies, compliance penalties, and damage to their competitive position.
Need Help or Have Questions?
MAOs with questions about their Q4 2024 report should contact CMS at:
- Email: RiskAdjustmentOperations@cms.hhs.gov
- Subject Line: “Encounter Data Submission Performance Report, Q4 2024 Update”
Proactive outreach and clarification can help avoid errors in future submissions and strengthen organizational readiness for upcoming audits and payment reconciliations.
