Your plan members may suffer from conditions that have gone undocumented during the reporting year. In these cases, the associated hierarchical condition categories (HCCs) were likely not submitted to CMS or considered in your plan’s risk calculation. If that is the case, you may be seriously underreporting your risk and losing crucial revenue to help appropriately care for these members based on their conditions.
Our report highlights actions that you can take now to improve the accuracy of your submission data.
The report features:
- A detailed explanation of the ACA payment model
- An example of how capturing one member’s HCCs will impact his risk score
- Advice for completing supplemental work to accurately measure and report a member’s Risk Adjusted Factor (RAF) prior to CMS’s submission deadline