The “Rxisk” of adjustments in 2018 ACA risk adjustment
18 August 2017
The Centers for Medicare and Medicaid Services (CMS) is adding a new prescription drug category classification system to the 2018 risk adjustment model. Starting in 2018, a condition will be identified through a Hierarchical Condition Category with associated medical diagnosis codes, a prescribed medication, or both—each one affecting the final risk member score differently. This paper approximates the likely CMS mapping based on the publicly available information to date.
About the Author(s)
Alan Vandagriff
The “Rxisk” of adjustments in 2018 ACA risk adjustment
The Centers for Medicare and Medicaid Services (CMS) is adding a new prescription drug category classification system to the 2018 risk adjustment model, and this paper approximates the likely CMS mapping based on the publicly available information to date.
Michael Hunter, Michelle Klein, Jason Petroske, Alan Vandagriff