CMS Announces Final 2021 HCC Risk Adjustment Changes

CMS Announces Final 2021 HCC Risk Adjustment Changes

For health plan providers, it is essential to stay up to date on any HCC risk adjustment changes that come about. Recently, the Centers for Medicare & Medicaid Services (CMS) published their final Medicare Advantage and Part D payment methodologies for the calendar year 2021. In this, they announced some changes to the HCC risk adjustment.

Medicare Advantage Plans (Part C) 2021 Payments

Currently, the 2020 CMS HCC model is being phased in as we prepare for full implementation in 2022. The CMS uses diagnosis codes submitted to MA organizations as part of RAPS, and in 2021, there are some changes to MA plans Part C payments. The risk score calculations will be weighted according to the following:

  • 75% of the risk score calculated with the 2020 CMS-HCC model
  • 25% of the risk score calculated with the 2017 CMS-HCC model

As you can see, the weight of the calculations is being shifted away from the 2017 CMS-HCC model and towards the 2020 model.

ESRD and Kidney Organ Acquisition Costs for 2021

In addition to the changes to Medicare Advantage Plans (Part C) payments, the ESRD and Kidney Organ Acquisition Costs are also changing for 2021. Starting in 2021, those with End-Stage Renal Disease (ESRD) can enroll in MA plans if they choose. This goes into effect on January 1, 2021.

Need help with your HCC coding? Contact HCC Coders today!

If you are struggling to keep up with the constantly changing HCC risk adjustment methodologies you are not alone. There is likely enough on your plate without having to plan for constant changes. Thankfully, HCC Coders is here to help. If you are in need of any help with your HCC coding work, count on us. We offer a full suite of services to health plan providers, including:

  • Medical record retrieval services
  • Access to HCC coding software
  • Complete, outsourced handling of all coding activities
  • In-depth, focused Retrospective Chart Reviews
  • Validation of ICD 10 diagnosis codes with medical records
  • Highlighting of any key coding or documentation errors or omissions
  • Inclusion of Part C and Part D coding in HCC data capture
  • Concurrent coding
  • Prospective risk adjustment coding
  • Physician Chart Audit summary reports
  • Identification of opportunities for coding improvement and education

If you need assistance, give us a call today at 877-328-2343!

To learn more about the reliable and quality HCC coding services that we offer, visit us on the web at HCC coding.