For 2022, the Facilities for Medicare and Medicaid Providers is proposing to use only come upon details in calculating threat adjustment utilised to pay Medicare Gain strategies.
The Section C threat score would count completely on come upon details as the supply of MA diagnoses, CMS claimed in releasing Section I of the 2022 Medicare Gain Advance Observe.
This signifies a transform from the blend for 2021 of seventy five% of the threat score calculated employing the 2020 CMS-HCC design and 25% of the threat score calculated employing the more mature 2017 CMS-HCC design.
WHY THIS Issues
The transform is demanded by the twenty first Century Cures Act.
CMS calculates threat scores employing diagnoses submitted by MA organizations and from Medicare rate-for-provider promises.
Historically, CMS has utilised diagnoses submitted into CMS’ Danger Adjustment Processing Procedure (RAPS) by MA organizations for the goal of calculating threat scores for payment.