Risk Adjustment Methodology Series
The Risk Adjustment Methodology training series provides 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 the upcoming calendar year, with specific sample calculations.
Module 1: An Overview of Risk Adjustment - This module covers the foundations of risk adjustment, the legislative history, and how CMS-HCC (Part C) and RxHCC (Part D) models are used for risk adjustment.
Module 2: Risk Score Calculation - This module guides plans in identifying demographic and diagnostic information used for risk score calculation from reports for Part C and D models, provides a risk score formula overview, and explores the steps to choose the appropriate risk adjustment model and calculate a risk score.
Module 3: Scenarios - This module shows 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 risk score calculation steps.
Risk Adjustment Methodology: Modules 1 – 3 Computer-Based Training
Module 4: 2023 Payment Year Updates and Sample Calculations - This module highlights both what changed for Payment Year 2023 (i.e., Calendar Year 2023) and what remained the same. It also allows the learner to follow along in identifying the correct risk adjustment model factors and completing the risk score calculation steps, as illustrated in Module 3.
Module 5: 2024 Calendar Year Updates and Guided Practice - This module highlights both what changed for Calendar Year 2024 and what remained the same. Module 5 demonstrates how to identify the correct risk adjustment model factors and complete the risk score calculation steps, inviting the learner to participate in a guided practice activity. For Calendar Year 2024 for the Part C model, two risk scores are blended for payment. The guided practice shows the learner how to calculate a blended risk score for a Part C beneficiary (not in ESRD or in a PACE plan).
Module 6: 2025 Calendar Year Updates and Sample Calculations – This module highlights both what changed for Calendar Year 2025 and what remained the same. Module 6 demonstrates how to identify the correct risk adjustment model factors and complete the risk score calculation steps for a Part C beneficiary (not in ESRD or in a PACE plan) and a Part D beneficiary using the risk adjustment policies finalized for calendar year 2025.