2023 CMS Advance Notice of Methodological Changes for Calendar Year (CY) 2023 for Medicare Advantage (MA) Plans

CMS has released their Advanced Notice for CY 2023. Highlights for risk adjustment include:

Section G. CMS-HCC Risk Adjustment Model for CY 2023 page 42

For CY 2023, CMS will continue to calculate 100 percent of the risk score using the 2020 CMSHCC model, which we began phasing in with CY 2020 payment as described in Part I of the CY 43 2020 Advance Notice.10 The 2020 CMS-HCC model complies with the revisions to the risk adjustment for MA payments required by section 1853(a)(1)(I) of the Act, as amended by the 21st Century Cures Act.

Section M. Sources of Diagnoses for Risk Score Calculation for CY 2023 Page 67

then Attachment III, Section A. RxHCC Risk Adjustment Model Page 68

Advance Notice of Methodological Changes for Calendar Year (CY) 2023 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (cms.gov)

159 pages

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Guidelines for HIV coding

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Preliminary ICD-10-CM CMS HCC Mappings

The link below take you to the Preliminary ICD-10-CM Codes, CMS-HCC and RxHCC Models, Includes FY2014 preliminary list of ICD-10 codes HCC Mappings from CMS. Last modified 9/30/2014. Preliminary ICD-10-CM Mappings Diagnosis Code Description CMS-HCC PACE/ESRD Model Category V21 CMS-HCC Model Category V22 (clinically revised model implemented in 2014) RxHCC Model Category V04 CMS-HCC PACE/ESRD Model for 2015 Payment Year CMS-HCC Model for 2015 Payment Year RxHCC Model for 2015 Payment Year #HCC #ICD10 #CMS #ICD9 #RiskAdjustment #MedicalCoding #Mappings Disclaimer : This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to s...

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