The CMS Quality Payment Program is comprised of four categories for Year 2: Cost, Quality, Promoting Interoperability, and Improvement Activities. Over half of your MIPS final score is made of Cost and Quality, which is a change for Year 2. While the Cost category does not require a submission, reviewing the feedback reports from CMS is essential to understanding your practice’s historical cost performance. This allows you to target strategic interventions for improvement in both cost and quality categories.

One method to gain a better understanding of the patients attributed to your practice is through identifying the Hierarchical Condition Category or HCC used for risk adjustment. A CMS Hierarchical Condition Categories (CMS-HCC) model generates a risk score for each beneficiary. CMS uses these CMS-HCC risk scores in the risk adjustment methodology for Medicare Advantage. This score summarizes each beneficiary’s expected cost of care relative to other beneficiaries using a mixture of demographics and diagnoses. Separate CMS-HCC models exist for new enrollees and continuing enrollees. The new enrollee CMS-HCC model accounts for each beneficiary’s age, sex, and disability status, and is used when a beneficiary has less than twelve months of medical history. The continuing enrollee CMS-HCC model accounts for each beneficiary’s age, sex, original reason for Medicare enrollment (age or disability), Medicaid enrollment, and clinical conditions as measured by CMS-HCCs.

Join us on our upcoming webinar as we take a closer look into the approach and factors CMS uses to determine a patient’s HCC score and how you can use this information to select clinical and process interventions to improve patient outcomes.

QPP Year 2 Webinar – What is a HCC Score and What Does it Tell You About Your Patients?

Thursday June 21st 12-1 p.m. ET