HCC Risk Adjustment Model

wilkatm40@gmail.com

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Hi wanted to know can someone tell me where I can find information on how to read CMS-HCC model chart? I don’t understand it when you drop a number and use a number. I hope that make since
 

Pathos

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Because there are many components involved in Risk Adjustment, explaining the subject can be a bit lengthy and time consuming. When you state "drop a number and use a number", what are you referring to? Do you mean how do you look up an HCC? or calculate the RAF score? or use the HCC grouping?

Here are some links for you to get started:

Medpartners - Risk Adjustment 101 - a little bit sales pitchy, but still good info.
Availity - RA 101 - a little bit sales pitchy, but still good info.
CMS Risk Adjustment page
CMS Risk Adjustment Report to Congress (200+ pager!)

Let me know if you have more questions.

Thanks!
 

wilkatm40@gmail.com

Contributor
Messages
16
Best answers
0
Because there are many components involved in Risk Adjustment, explaining the subject can be a bit lengthy and time consuming. When you state "drop a number and use a number", what are you referring to? Do you mean how do you look up an HCC? or calculate the RAF score? or use the HCC grouping?

Here are some links for you to get started:

Medpartners - Risk Adjustment 101 - a little bit sales pitchy, but still good info.
Availity - RA 101 - a little bit sales pitchy, but still good info.
CMS Risk Adjustment page
CMS Risk Adjustment Report to Congress (200+ pager!)

Let me know if you have more questions.

Thanks!
Chart has HCC numbers 27,28&29 in first column third column has29, 30, 31 and a condition might be 30 and another 31. Which would be used for calculating. I hope I explained correctly
 

Pathos

True Blue
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604
Location
Beaverton OR
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Hi Willkatm,

So the HCC numbers you are referring to are the HCC groups, and they will override each other. Meaning, if you send two or more conditions that are under HCC 29, then you will only receive payment for the one condition in that grouping. This is a very simplistic way of explaining it, as there are many other components to the equation (Medicaid elig, Disability, Sex, Geographics, Disease interactions, etc.).

Hope that guides you somewhat! Risk Adjustment and RAF scores can be a little tricky, I recommend looking at some of the resources I sent you.
 
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