Important Info You Need to Know from CMS Call Letter The Centers for Medicare and Medicaid Services (CMS) has published the Medicare Advantage Final Call Letter for the calendar year 2022, including updates to Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies.

What time of the year does CMS reset all patient risk scores?

January 1
Likewise, if additional conditions are reported, the patient’s risk score will increase from what it was in the previous year. Because risk scores reset every January 1, the person’s base risk score for that year reflects only the demographic factors.

What blending percentage is considered for the year 2020 CMS HCC risk model?

50%
CHANGES IN ESRD/PACE PAYMENT METHODOLOGY FOR CY2020 For CY2020, the risk score will be a blend of 50% of the risk score using the 2019 ESRD models, using diagnoses from RAPS and FFS, and 50% of the risk score using the 2020 ESRD models, using diagnoses from encounter data, RAPS inpatient records, and FFS.

How many risk adjustment models are there?

Fifteen separate models are developed. For each age group (adult, child, and infant), a model is developed for each cost sharing level (platinum, gold, silver, and bronze metal levels, as well as catastrophic plans).

How many CMS-HCC categories are there for 2021?

86 categories
For 2021, there are over 71,000 ICD-10-CM diagnosis codes in 86 categories for the CMS-HCC Version 24 risk adjustment model. HCCs reflect hierarchies among related disease categories.

How is RAF score calculated?

Individual scores/weights are assigned to patient demographics and HCCs and then added together to calculate the total risk adjustment factor (RAF) score. RAF scores are then multiplied by the published denominator ($9,050 as of 2014) to derive an expected annual expenditure.

What are the annual testing requirements under the CMS emergency preparedness final rule?

Testing exercises required under the Final Rule are divided into two categories: 1) full-scale, functional and individual-facility-based exercises as the “Required Exercises” and 2) mock disaster drills, table-top exercises or workshops as the “Exercises of Choice.” Inpatient providers are required to conduct an …