Survey analyzes differences between Medicare Advantage RAPS and EDS risk scores

As the Centers for Medicare and Medicaid Services (CMS) continues to phase out the Risk Adjustment Payment System (RAPS) as a source for risk adjustment diagnoses, it is important that Medicare Advantage organizations (MAOs) understand the expected impact of the Encounter Data Processing System (EDS) as the single source of diagnoses for calculating risk scores and the impact this transition may have on revenue.

Milliman professionals have periodically conducted surveys that identified the average difference between RAPS-based and EDS-based risk scores. The most recent survey results show that EDS scores have now caught up to or exceeded RAPS scores in many cases, whereas surveys from prior years showed that EDS were generally lower than RAPS scores.

Milliman actuaries David Koenig, Emily Vandermause, and Rebecca Gergen discuss the results in their paper entitled “Have we reached parity between Medicare Advantage RAPS and EDS risk scores?