Risk Adjustment Methodology

The Risk Adjustment Methodology is a training series which will provide Medicare Advantage Organizations and Prescription Drug Plans with a high level overview of risk adjustment, followed by a deep dive into the risk score calculation process and sample calculations for specific scenarios. This series will be updated annually to provide an overview of the changes for upcoming payment years, with specific sample calculations.

Module 1: An Overview of Risk Adjustment - This module covers the foundations of risk adjustment, the legislative history, and how HCC and RxHCC models are used for risk adjustment.

Module 2: Risk Score Calculation - This module will guide plans in identifying demographic and diagnostic information used for risk score calculation from reports for Part C and D models, provide a risk score formula overview, and explore the process steps to choose the appropriate risk adjustment model and calculate a risk score.

Module 3: Scenarios - This module will show risk score calculations using the various risk adjustment models and allows the learner to follow along in identifying the correct risk adjustment model factors and completing the calculation steps.

Risk Adjustment Methodology: Modules 1 – 3 Computer-Based Training

Module 4: 2023 Payment Year Updates and Sample Calculations – Overview of the updates for Payment Year 2023, and three scenarios highlighting key changes in ESRD and Part D (RxHCC) models.This module will highlight both what changed for Payment Year 2023 and what has remained the same. It also allows the learner to follow along in identifying the correct risk adjustment model factors and completing the calculation steps, as illustrated in module 3.

Risk Adjustment Methodology: Module 4 Computer-Based Training.