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2015 HCC Model Changes

The purpose of the CMS-HCC risk adjustment model is to adjust payments for Part C benefits offered by Medicare Advantage plans. Cognisight has prepared a presentation highlighting the PY2015 changes.

For PY2014, CMS used a blended model when calculating risk score payments to health plans by taking 25% of the 2013 HCC Model 12 and 75% of the 2014 HCC Model 22. Although it was expected that CMS would fully phase in Model 22 by PY2015, CMS announced in the Final Call Letter on April 7, 2014 that the HCC blended model would continue. For PY2015, CMS will use a blended risk score for each member by taking 67% of the 2013 HCC Model 12 and 33% of the 2014 HCC Model 22 each appropriately normalized.

To download the presentation slides, please click here.