On September 14, 2020, the Centers for Medicare & Medicaid Services (“CMS”) issued the Advance Notice of Methodological Changes for Calendar Year (CY) 2022 for Medicare Advantage (MA) Capitation Rates ...

Risk adjustment for patient experience measures needs to be modified by including the CMS Hierarchical Condition Categories (HCC) risk scores of home health beneficiaries. Conclusions: A negative ...

For 2022, the Centers for Medicare and Medicaid Services is proposing to use only encounter data in calculating risk adjustment used to pay Medicare Advantage plans. The Part C risk score would rely ...

"Modifying the HCC model is not a simple technical update or revision," the AMGA says. CMS recently released proposed changes to the CMS-HCC Risk Adjustment Model for payment year 2024 in February, ...

Among other provisions, the Rate Announcement includes the following: Payment Changes/Growth Rates: The effective growth rate for 2024 MA non-End-Stage Renal Disease (ESRD) rates is 2.28%, a slight ...

Accurate risk adjustment isn’t just a box to check; it’s now a strategic lever. Hierarchical Condition Category (HCC) coding underpins risk scores that drive Medicare Advantage and other value-based ...

The Centers for Medicare & Medicaid Services said it plans to begin in 2022 using solely encounter data to calculate risk adjustment in Medicare Advantage and Part D. CMS released Part I of its annual ...

In 2020 Medicare reintroduced Alzheimer’s disease and related dementias (ADRD) Hierarchical Condition Categories (HCCs) to risk-adjust Medicare Advantage and accountable care organization (ACO) ...

Claims data, which form the foundation of risk adjustment in payment for health care services, may reflect efforts to capture more—or more severe—clinical conditions rather than true changes in health ...

Incorporating functional status in diagnosis-based risk adjustment measures may modestly improve overall expenditure prediction for beneficiaries with substantial disabilities, but not prescription ...

Medicare Advantage plans get a 1.66% rate increase for 2021, which is higher than the .93% the Centers for Medicare and Medicaid Services announced in its advance rate notice. CMS on Monday published ...