The CMS-HCC risk adjustment model is used to calculate risk scores to adjust capitated payments made for aged and disabled beneficiaries enrolled in Medicare Advantage (MA) plans and certain demonstrations.
Risk Adjustments, in addition, are used to access an illness or severity and comparing classifications of diseases using diagnosis codes.
Using the risk adjustment calculator offers support on how to accurately code and report risk and HEDIS. The Risk Calculator offers a tool that gives you the ability to search for risk calculations on an individual.
The following models may be used for calculating risk scores:
- CMS-HCC - Used to calculate the risk score for Medicare beneficiaries
- ESRD- HCC- Used to derive risk assessment on End-stage renal disease
- Rx-HCC Used for prescription drug hierarchical conditions for risk adjustment programs
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