March 2025 Medicare Advantage/Prescription Drug System Payments Explained
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 Centers for Medicare & Medicaid Services (CMS) is set to release the March 2025 Medicare Advantage and Prescription Drug payment, which includes key adjustments and updates. This communication highlights changes such as risk adjustment overpayment rerun for 2017, corrections from the MARx data cleanup, and coverage gap discount offsets. Organizations should particularly note corrections related to technical issues impacting 2017 overpayments and adjustments for updated Part D risk factors.
Key Dates and Deadlines
- Payment Scheduled for Receipt: February 28, 2025
- Submission Deadline for 2017 Risk Adjustment: July 31, 2024
- Rerun of Payment Year (PY) 2017 Memo Date: June 28, 2024
- Voluntary Part D Premium Stabilization Demo Memo Date: July 29, 2024
PACE Compliance
This memo is relevant to PACE programs because it outlines important payment updates and adjustments related to the Medicare Advantage and Prescription Drug System (MARx), which may impact the financial processes and compliance for PACE organizations. The following points are of particular importance:\n\n
PACE organizations need to be aware of the adjustments from the risk adjustment overpayment rerun for payment year 2017 included in the March 2025 payment. These adjustments may affect the payment calculations and require organizations to verify their received payments against expected amounts.
Correct adjustments regarding overpayments and risk factor changes will be made in future payment months. PACE organizations should monitor MARx monthly payment letters in the Health Plan Management System (HPMS) for updates.
The memo highlights a MARx data cleanup related to Part D risk factors that might be relevant to PACE organizations. The cleanup adjusts risk factors from ‘New Enrollee’ to ‘Continuing Enrollee’, and payments will reflect these adjustments in March 2025. Organizations should review these adjustments to ensure accuracy in their financial reporting.
PACE organizations participating in the voluntary Part D Premium Stabilization demonstration should be aware that the January and February payments under this demonstration will include retroactive payment adjustments. They should review these adjustments for accuracy.
There is an identified MARx software issue affecting premium payment option updates. PACE organizations must verify that premium payment options and the amounts are correctly updated in the SSA records to avoid discrepancies in beneficiary premium withholds.
Overall, PACE organizations are advised to regularly review payment reports and adjustments from CMS to ensure compliance and correct any discrepancies promptly. Keeping an eye on communication from CMS regarding these updates will ensure organizations remain compliant with PACE requirements.
Required Actions
1. Review the March 2025 Monthly Membership Report (MMR) for adjustments from the 2017 risk adjustment overpayment rerun, identifying any discrepancies and adjustments with Adjustment Reason Code (ARC) 25 and 37.
2. Monitor the MARx monthly payment letters in the Health Plan Management System (HPMS) for updates regarding corrections to adjustments resulting from the technical issue concerning the 2017 overpayment run, specifically regarding long term institutional and community risk factors.
3. Verify payment corrections in the March 2025 payments for participating Employer Group Waiver Plans (EGWPs) under the Voluntary Part D Premium Stabilization Demonstration, ensuring retroactive payment adjustments for January and February 2025 are accounted for.
FAQs
- “What adjustments are included in the March 2025 Medicare Advantage/Prescription Drug payment?”
- “How are the 2017 risk adjustment overpayments being handled for long term institutional beneficiaries?”
- “What issues were identified with the MARx software related to premium withholdings?”
- “How does the conversion of the MARx system to Amazon Web Services affect current processing?”
- “What is the impact of sequestration on retroactive payment adjustments?”
