Risk Adjustment

CMS Advanced Notice Part II

While the basic structure of the model and the HCCs will remain the same, CMS proposes the following two updates to the ESRD model for 2019:


1. Update the data years underlying the model, and;
2. Update the Medicaid factors to be concurrent with the payment year.

Overall, CMS is projecting a 1.84% overall increase to Medicare Advantage revenue, based on an effective growth rate of 4.35% offset primarily by a decrease in normalization of -2.26%. As with everything else, it all depends on your member make-up and geography.

Download the notice here


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