Page Last Updated 5/26/2016
CMS-HCC Model Tools
This document contains the 2016 CMS-HCC Mappings in ICD-10, along with the Risk Adjustment Factor (RAF) score for each HCC.
- Last Updated: 5/26/2016
- 2,122 KB
CMS has released the final MA rates for Part C and Part D, along with information on changes to the Stars program. The 2016 payment (2015 dates of service) will be based on 100% of the 2014 CMS-HCC Model. Last year, there was a blend of the 2013 CMS-HCC and 2014 CMS-HCC models by 67 percent and 33 percent, respectively.
- Last Updated: 4/7/2015
- 1,856 KB
- Last Updated: 4/7/2014
- 883 KB
CMS has posted the combined 2015 Announcement of Methodological Changes for Calendar Year (CY) 2015 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2015 Call Letter. The following keychanges to the Advance Notice were made:
2015 payment year we will blend the risk scores calculated using the 2013 CMS-HCC and 2014 CMS-HCC models by 67 percent and 33 percent, respectively.
CMS is not implementing, for 2015, the proposed policy to exclude, for payment purposes, diagnoses identified during a home visit that are not confirmed by a subsequent clinical encounter.
CMS will use both Full Encounter Data and RAPS data to calculate 2015 payment. CMS will notify us when Full Encounter Data alone will be used
There are a number of other important changes, and we recommend you review the notice fully.
On 4-1-2013, CMS published the attached final notice of Part C & D Rates for 2014. In addition to a new CMS-HCC Model, CMS has announced the implementation of collection of information related to Health Risk Assessments in 2014, and Coding Intensity Adjustment for 2014 payment.
- Last Updated: 4/1/2013
- 1,322 KB
This file contains multiple tabs, which include all of the 2013 Payment Year HCC coefficients and factors.
- Last Updated: 1/11/2013
- 63 KB
This file contains the CMS-HCC diagnosis code groupings, with documentation and coding information for problematic diagnosis codes.
- Last Updated: 4/20/2011
- 403 KB
This file contains the diagnosis mappings for the CMS-HCC, ESRD/PACE-HCC and RxHCC models for the 2012 payment year (2011 service year).
- Last Updated: 4/8/2011
- 578 KB
ICD-9-CM Codes, CMS-HCC and RxHCC models.
- Last Updated: 9/29/2010
- 471 KB
This final FY 2016 file contains all diagnosis codes for all CMS Medicare Advantage Risk Adjustment models for dates of service from 10-1-2015 to 9-30-2016.
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This file contains the diagnosis mappings for the CMS-HCC Model for the 2013 payment year (2012 dates of service).
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This file contains the diagnosis codes at their highest level of specificity for the 2014 CMS-HCC model. These codes were taken from the CMS-HCC SAS software at https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Risk_adjustment.html.
- 128 KB