CMS is under pressure from the Office of Inspector General, the Medicare Payment Advisory Commission and elected officials to stop using diagnoses from chart reviews or health risk assessments for payment adjustments.
In response, the agency has begun a three-year phase-in of the updated Part C Risk Adjustment model, known as the 2024 CMS-HCC model. This new model removes many diagnosis codes derived solely from chart reviews and health risk assessments.
There is speculation that CMS might completely disallow these methods in the future, which could significantly impact Medicare Advantage plans. This session will explore the potential disruptions and how payers can best prepare.
Key learnings:
- Why CMS may abandon retrospective chart reviews and IHAs
- What a future without these two intervention activities might look like
- What Medicare Advantage plans can do now to prepare
- Why plans need to partner with providers to capture comprehensive risk adjustment data
