منابع مشابه
Mispricing in the medicare advantage risk adjustment model.
The Centers for Medicare and Medicaid Services (CMS) implemented hierarchical condition category (HCC) models in 2004 to adjust payments to Medicare Advantage (MA) plans to reflect enrollees' expected health care costs. We use Verisk Health's diagnostic cost group (DxCG) Medicare models, refined "descendants" of the same HCC framework with 189 comprehensive clinical categories available to CMS ...
متن کاملHow Does Risk Selection Respond to Risk Adjustment? New Evidence from the Medicare Advantage Program.
To combat adverse selection, governments increasingly base payments to health plans and providers on enrollees’ scores from risk-adjustment formulae. In 2004, Medicare began to risk-adjust capitation payments to private Medicare Advantage (MA) plans to reduce selection-driven overpayments. But because the variance of medical costs increases with the predicted mean, incentivizing enrollment of i...
متن کاملWill risk-adjustment decrease health care costs? New evidence from the Medicare Advantage Program∗
To combat adverse selection, governments increasingly base payments to health plans and providers on enrollees’ scores from risk-adjustment formulae. But because the variance of medical costs increases with the predicted mean, incentivizing enrollment of individuals with higher scores can increase the scope for enrolling “over-priced” individuals with costs significantly below the formula’s pre...
متن کاملMedicare Risk Adjustment for the Frail Elderly
CMS has had a continuing interest in exploring ways to incorporate frailty adjustment into the CMS Hierarchical Condition Categories (CMS-HCC) risk adjustment methodology for Medicare Advantage and other Medicare private organizations. In this article we present research results for Medicare risk adjustment of the frail elderly since the adoption of frailty adjustment for Program of All-Inclusi...
متن کاملPrincipal Inpatient Diagnostic Cost Group Model for Medicare Risk Adjustment
The Balanced Budget Act (BBA) of 1997 required HCFA to implement health-status-based risk adjustment for Medicare capitation payments for managed care plans by January 1, 2000. In support of this mandate, HCFA has been collecting inpatient encounter data from health plans since 1997. These data include diagnoses and other information that can be used to identify chronic medical problems that co...
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ژورنال
عنوان ژورنال: INQUIRY: The Journal of Health Care Organization, Provision, and Financing
سال: 2015
ISSN: 0046-9580,1945-7243
DOI: 10.1177/0046958015583089