April 2025 Medicare Advantage Payments and Adjustments: Key Updates for Plans
Relevant to: PDP, Enrollment and Payment Systems, PACE, Part D
Each week, we scan the latest CMS memos to find the most important ones that apply for PACE programs. Below is a summary of what you need to know.
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Introduction
The April 2025 Medicare Advantage and Prescription Drug System payment update encompasses crucial adjustments and error rectifications that organizations need to be aware of. Scheduled for distribution on April 1, 2025, these payments include corrections for previous risk adjustment overpayments for the years 2017 and 2018, as well as updates related to the conversion of the MARx system to a cloud-based architecture. CMS is prioritizing the resolution of identified discrepancies and continues to provide guidance and support for any issues encountered during the transition.
Key Dates and Deadlines
- April 01, 2025: Scheduled receipt of April 2025 Medicare Advantage/Prescription Drug payment.
- February 28, 2025: Memo addressing the technical issue for PY 2017 sent.
- September 30, 2024: Deadline for successful submission of RAPS and EDPS data for PY 2018.
- August 29, 2024: Memo regarding rerun of Payment Year 2018 issued.
- July 2023: Conversion of MARx to Amazon Web Services (AWS) occurred.
Required Actions
This document outlines the necessary actions related to the April 2025 Medicare Advantage/Prescription Drug payment.
- Review the April Monthly Membership Report (MMR) for adjustments related to PY 2017 and PY 2018 Risk Adjustment Overpayment Rerun with ARC 25 and ARC 37 codes.
- Check the Plan Payment Report (PPR) for the CY2023 Coverage Gap Discount (CGD) reconciliation labeled under ‘Special CMS Adjustments’ with the type ‘PRS.’
- Monitor communications from CMS regarding discrepancies in MARx calculations and report any unresolved issues related to enrollment, premium, and payment information to the MAPD Help Desk if not already submitted.
FAQs
- What is the Medicare Advantage/Prescription Drug System (MARx)?
- How are the risk adjustment overpayment reruns for PY 2017 and PY 2018 addressed?
- What changes have been made to the MARx system in 2023?
- What is the current sequestration policy for retroactive payment adjustments?
- How can I contact the MAPD Help Desk for further inquiries?
