Risk Adjustment of Medicare Capitation Payments Using the CMS-HCC Model
Top Cited Papers
- 1 January 2004
- journal article
- Vol. 25 (4) , 119-141
Abstract
This article describes the CMS hierarchical condition categories (HCC) model implemented in 2004 to adjust Medicare capitation payments to private health care plans for the health expenditure risk of their enrollees. We explain the model's principles, elements, organization, calibration, and performance. Modifications to reduce plan data reporting burden and adaptations for disabled, institutionalized, newly enrolled, and secondary-payer subpopulations are discussed.Keywords
This publication has 12 references indexed in Scilit:
- Clinical Risk Groups (CRGs)Medical Care, 2004
- Understanding Biased Selection in Medicare HMOsHealth Services Research, 2003
- Principal Inpatient Diagnostic Cost Group Model for Medicare Risk Adjustment2000
- Evaluating Alternative Risk Adjusters for Medicare1998
- Risk-Adjusted Medicare Capitation Rates Using Ambulatory and Inpatient Diagnoses1996
- Diagnosis-Based Risk Adjustment for Medicare Capitation Payments1996
- Health Status of Medicare Enrollees in HMOs and Fee-for-Service in 19941996
- Refinements to the Diagnostic Cost Group (DCG) model.1995
- Do Health Maintenance Organizations Work for Medicare?1993
- Adjusting Medicare capitation payments using prior hospitalization data1989