The Centers for Medicare and Medicaid Services (CMS) has published the final payment policy document for Medicare Advantage plans for the calendar year (CY) 2024. The announcement also included the new CMS-HCC risk adjustment model (v28 or 2024). This new model will replace the current CMS-HCC model (v24 or 2020) in a phased manner.
The changes in the 2024 model are significant. According to CMS projections, the RAF score of an average Medicare Advantage population will decrease by 3.12% in the new model compared to the current model. Taking average risk score trends into consideration, the 2024 risk scores would have an overall trend of 4.44%, compared to what would have been 5% under the existing risk adjustment model. The new model was also recalibrated to be based on ICD-10 codes; the existing model was originally designed based on ICD-9 codes.
To facilitate a smooth transition to the new model, healthcare providers, including Accountable Care Organizations (ACOs), Clinically Integrated Networks (CINs), and Medicare Advantage payers, will need to quickly embrace the changes. They must analyze the ICD-10 and HCC level data comprehensively and accurately capture the risk profile of their populations.
Percept Health provides a comprehensive risk adjustment analytics insights app and healthcare data ops service that can help healthcare providers and Medicare Advantage payers with this transition. Our significant risk adjustment experiences can help organizations stay on top of these changes and navigate the journey smoothly. To learn more about how Percept Health can prepare you for this journey, contact us today.
Read on, for the summary of the CMS-HCC 2024 model.