CMS has announced a new CMS-HCC Model for payment
year 2014 in their combined Announcement of Calendar Year (CY) 2014
Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment
Policies and Final Call Letter, published April 1, 2013. You can download a copy of the ICD-9 codes
that CMS released at the time of the Advance Notice [here]. CMS has not informed us of any changes in
this listing, but we will advise you immediately if they do.
Important
provisions of the announcement, related to Risk Adjustment:
•
Clinically Revised CMS-HCC Model. CMS will implement the new risk adjustment
model, but will phase-in changes over a two year period. In 2014, CMS will blend 75 percent of the
2014 model risk score with 25 percent of the 2013 model risk score. The new model will be fully phased-in by
January 1, 2015.
•
Medicare Enrollee Health Risk Assessment. As we noted when the Advance Notice was
published, CMS is considering excluding from risk adjusted payment any diagnosis
data collected from MA enrollee Health Risk Assessments which are not confirmed
by a subsequent clinical encounter. CMS
planned to collect flags in 2013 of these risk assessments.
Based on comments received, CMS is delaying the collection of flags until
calendar year 2014. Further
determination about exclusion of these data will be published in the 2015
Advance Notice
•
Coding Intensity Adjustment. The Coding Intensity Adjustment for 2014 is 4.91
percent.
•
Normalization Factor. Because 2014 payment will be based on a blend
of the old and new CMS-HCC Models, there will be two normalization factors:
•
2013 CMS-HCC model: 1.041.
•
2014 CMS-HCC model: 1.026.
You can review all of the
changes for 2014 in the Announcement, posted [here]. Look for new training programs to help SCAN
providers understand the changes to the model on HCC University soon!
