For 2022, the Centers for Medicare and Medicaid Services is proposing to use only come across details in calculating threat adjustment applied to pay out Medicare Gain designs.
The Part C threat rating would rely solely on come across details as the resource of MA diagnoses, CMS mentioned in releasing Part I of the 2022 Medicare Gain Progress Discover.
This signifies a transform from the blend for 2021 of seventy five% of the threat rating calculated using the 2020 CMS-HCC product and 25% of the threat rating calculated using the older 2017 CMS-HCC product.
WHY THIS Matters
The transform is demanded by the 21st Century Cures Act.
CMS calculates threat scores using diagnoses submitted by MA businesses and from Medicare charge-for-service statements.
Traditionally, CMS has applied diagnoses submitted into CMS’ Risk Adjustment Processing Program (RAPS) by MA businesses for the objective of calculating threat scores for payment.
In modern yrs,