For CY 2024 payments, risk scores are calculated as a blend of 67 percent of the risk scores calculated with the 2020 CMS-HCC model and 33 percent of the risk scores calculated with the updated 2024 CMS-HCC model. For CY 2025, CMS proposes to continue to phase in the implementatio...
The finalized Medicare Advantage risk adjustment model followed the process outlined by the 2020 CMS-Hierarchical Condition Categories (HCC) model. Per the 21st Century Cures Act, CMS has to phase in the established risk adjustment changes over three years. For contract year (CY)...
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...
In the first part of its Advance Notice for calendar year 2022, CMS has proposed completely phasing in the CMS-Hierarchical Condition Categories (HCC) for Medicare Advantage risk adjustment, finalizing the switch to encounter data. The fully phased-in model would use encounter data onl...
ct or mri Doc med pt reas no hcc scrn Pt no abd img no doc rsn Tob user recd cess interv Tob non-user No tob assess or cess inter No recd cortico>=10mg/d >60d Rec cortico>90d or 1rx 900mg No rec cortico>60d 1rx 600mg W/in 2yr dxa not order Chap services at hospice Diet...