The Medicare Advantage (MA) market is one of the most competitive landscapes in healthcare. Success and profitability often hinge on performance in the Medicare Stars Rating system, established by the Centers for Medicare & Medicaid Services (CMS).

This five-star quality scale ranges from five stars (excellent) to one star (poor) and is based on multiple measures such as member experience, outcomes, and management of chronic conditions. The financial stakes are high:

• High performers (4–5 stars) earn quality bonus payments and often attract more members by offering richer benefits.
• Low performers (under 3 stars) risk member losses, sanctions, and even termination from Medicare.

The Challenge: Predicting Stars Performance

Forecasting Stars outcomes is notoriously complex. Constant changes in CMS methodologies with shifting measure weights, evolving cut-points, and new metrics make accuracy difficult. Small discrepancies can tip scores, as recent appeals and lawsuits in the industry have shown. In this high-stakes environment, no datapoint is too small to ignore.

Why Precision Death Data Matters

When analyzing Stars performance, plans must scrutinize the denominator used in measure calculations.

Too often, organizations rely solely on deaths reported by the Social Security Administration (SSA) Death Master File (DMF) without realizing:

• Reporting delays or overlooked deaths can inflate denominators and skew results.
• Errors in date of death (DOD) reporting can directly affect Stars measures tied to eligibility or clinical interventions.

The Decline of the SSA DMF

For decades, the SSA DMF was treated as the gold standard. But since 2011, after privacy law changes, its accuracy has deteriorated. Today, it captures only about 16% of actual deaths. Worse, in the past six months, issues like random false deaths and living individuals misclassified as deceased have raised major concerns about its reliability.

Common Stars Pitfalls Linked to Death Data

1. Missing Deaths and Overlooked Deaths – Take medication adherence measures as an example. If a missed pharmacy fill is attributed to a member who had actually passed away, a plan’s adherence score will drop unfairly. This issue extends to other Stars measures on both the pharmacy and medical side, wherever eligibility is miscalculated.
2. Date of Death (DOD) Validation also Matters – In Stars calculations, “fact of death” isn’t enough it’s the exact date that matters. A one-week discrepancy could mean a member is incorrectly included or excluded from required screenings or encounters, putting measures at risk.

Steps Plans Should Take

Proactive Death Audits

To address the shortcomings of the SSA DMF, Berwyn created CertiDeath^®, a continuous monitoring solution that:

• Eliminates manual work of chasing enrollment file updates.
• Screens out false positives.
• Provides timely, validated death data so analytics teams can act before Stars reporting deadlines.

Retro Lookback Comparing Medicare Enrollment Transaction Updates for Known Deaths

CMS enrollment files are not immune to errors. Late or revised submissions (e.g., a March 1 DOD replacing an April 1 record) can flow through systems unnoticed but have big Stars implications. Plans should compare retroactive CMS updates against a comprehensive audit source like CertiDeath to catch costly discrepancies.

Don’t Wait Until Appeals Season

Every June, Stars and plan bid deadlines create intense pressure. Analytics teams don’t have the bandwidth to untangle year-old death data during this critical window. By using CertiDeath proactively, plans can surface issues early and avoid last-minute scrambles or disputes.

Recommendation: CertiDeath Monitoring and Consultative Partnership

CertiDeath offers Medicare plans consistency, accuracy, and efficiency they haven’t encountered before. Using proprietary databases, over 35 years of experience and a team of experts to validate results deliver the following results for our clients:

• 96.5% decedent identification with 99.9% accuracy
• Decedents are reported within days with accurate DOD
• Less than .03% false positive rate

CertiDeath is the trusted solution for thousands of organizations across the nation to deliver accurate data that is needed for the complexity of the Medicare Stars process.

Case Study

In the Spring of 2025, Berwyn assisted an MA plan sponsor in auditing their 2024 Stars data to look closely at medication adherence performance. In the data sample that was provided, CertiDeath identified deceased members that the MA plan had not been notified about and also found DOD discrepancies on some members that CMS had identified as deceased.