The CMS-HCC risk adjustment model itself, is prospective - it uses demographic information (age, sex, Medicaid dual eligibility, disability status) and a profile of major medical conditions in the base year to predict Medicare expenditures in the next year. Determining which diagnosis codes should be included, how they should be grouped, and how the diagnostic groupings should interact for risk adjustment purposes was a critical step in the development of the model.
Centric Healthcare Services’ approach to risk adjustment is both retrospective and prospective, combined with ongoing support and analysis, which assists our clients to achieve appropriate revenue and the quality of care in a proactive and efficient manner.
