If Medicare Advantage and Part D payments were like hospital rounds, then the September 2025 Payment Information is the chart you don’t want to skim too quickly. A few new notes, some important corrections, and the usual reminders are tucked inside — all of which could make a real difference to your bottom line.

So, grab your (virtual) stethoscope — let’s diagnose what’s changed.

1. Risk Adjustment Reconciliation Rerun (PY 2020)

Think of this like prescribing the wrong year’s drug formulary — CMS accidentally used the 2012 CPT/HCPCS list when reconciling 2020 risk scores. Oops.

That meant beneficiaries with Fee-for-Service enrollment during the data collection year didn’t have their scores aligned properly.

The fix? CMS reran the reconciliation for Payment Year 2020, and a rerun for PY 2021 (with 2020 codes) is already on deck.

Translation: Correct codes = correct payments. Accuracy matters.

2. User Fee Adjustments

Ever notice how hospital cafeteria prices mysteriously go up or down? Same idea here. The user fees for September got a little shuffle:

National Medicare Education Campaign (NMEC):
- MA-PD bumped up to 0.038% (from 0.023%).
- PDP dipped down to 0.0012% (from 0.024%).
Coordination of Benefits (COB): Holding steady at $0.078 per Part D member.

Not huge, but every fraction of a percent counts when you’re talking thousands of members.

3. Retroactive Cleanups (Because We All Miss a Spot Sometimes)

Several payment corrections landed this month — and if you’ve ever gone back to fix a charting error, you’ll appreciate the cleanup:

Frailty Factor Fix: Missing for 2023–2024 PACE enrollees.
Adjustment Display Glitch: Some 2023 payment adjustments went MIA.
New Enrollee Factors: Risk adjustment was misapplied in 2024 & 2025.
Part D Direct Subsidy: A handful of 2025 members were assigned zero risk factor.

You’ll see these changes as ARC 94 entries with unique cleanup IDs on your Monthly Membership Report (MMR).

4. Sequestration Reminder

Like the diet you swore you’d stick to — sequestration is still here. The 2% cut, paused during the pandemic, is now fully back since July 2022.

1% cut: April–June 2022.
2% cut: July 2022 onward.

So yes, it’s still trimming payments, month after month.

5. Reporting Payment Issues

If your premiums or payments don’t look right, don’t panic. Plans should submit trouble tickets to the MAPD Help Desk.

Pro tip: If lots of plans see the same issue, CMS may roll it into one big master ticket — like turning multiple patient complaints into a single case study.

Bottom Line

The September 2025 payment cycle is another reminder that details matter:

Correct codes = correct revenue.
Retroactive cleanups can help (or surprise) your books.
User fees may be tiny but worth tracking.
Sequestration isn’t going anywhere.

The takeaway? Stay vigilant. Monitor those reconciliations. And remember, even small adjustments can ripple into large financial impacts across your member population.

At Health Data Max, we make sure you don’t just react to changes — you get ahead of them. Our AI-powered platform helps plans monitor risk scores, validate chart documentation, and stay compliant while protecting revenue.

Ready to make payment accuracy stress-free? Visit Health Data Max to learn more.