CMS completed a reclassification of diagnostic codes to align the underlying HCCs with the ICD-10 classification system and risk adjustment principles. The 2024 CMS-HCC model includes fewer diagnosis codes for mental health conditions and diabetes than the 2020 CMS-HCC model (see FAQ). CY ...
The estimated prospective health status of the insureds, in turn, is determined using the CMS-HCC actuarial model. This model assigns a risk adjustment factor or risk score to each insured based upon diagnosis codes submitted to th...
Understanding RADV is important to appreciating the impact of this rule. Avalere has an excellent review of the rule and RADV.They explainthat CMS pays MA plans a capitated amount per member per month on a risk-adjusted basis using the CMS Hierarchical Condition Category (HCC) ri...