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2016 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 an updated presentation highlighting the PY2016 changes.

For PY2015, CMS continued a blended model when calculating risk score payments to health plans. This was calculated by taking 67% of the 2013 HCC Model 12 and 33% of the 2014 HCC Model 22, each appropriately normalized. For PY2016, CMS will fully phase in and use 100% Model 22.

To download the presentation slides, please click here.