decisionhealth Newsletters, Part B News - 2018 Issue 1 (January)
CMS proposes changes to Medicare Advantage scoring, new and revised HCCs
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Article Overview
This article explains a CMS proposal affecting Medicare Advantage risk adjustment and the associated HCC-based payment model. It is relevant to coders, compliance staff, and managed care professionals who work with diagnoses that influence risk scores, especially in behavioral health and kidney disease. The piece summarizes the proposed model changes, the types of condition categories being updated, and the broader policy context surrounding the payment methodology.
Why This Topic Matters
Medicare Advantage reimbursement can be influenced by diagnosis reporting and risk adjustment methodology. Understanding proposed HCC changes helps organizations assess how updates may affect documentation practices, coding workflows, and payment modeling.
What You Will Learn
- What CMS is proposing to change in the Medicare Advantage risk adjustment model
- How hierarchical condition categories are used in payment scoring
- Which broad condition groups are being added or revised in the proposed update
- What the alternative scoring approaches mean at a high level
- Why these proposed changes matter for Medicare Advantage providers and plans
Who Should Read This
- Medical coders
- Coding auditors
- Compliance professionals
- Revenue cycle staff
- Medicare Advantage plan administrators
- Physicians and practice managers
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