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Medicare Managed Care Manual - CMS

Medicare Managed care Manual chapter 7 Risk Adjustment Table of Contents (Rev. 118, 09-19-14) Transmittals for chapter 7 10 Introduction 20 Purpose of Risk Adjustment 30 Statutory and Regulatory Authority for Risk Adjustment 40 Role and Responsibilities of Plan Sponsors 50 History of Risk Adjustment 60 - Annual Schedule 70 Risk Adjustment Models- Overview Calibration of the CMS-HCC Risk Adjustment Models CMS-HCC Risk Adjustment Model Community, Institutional, and New Enrollee Segments Risk Score for Long Term Institutionalized Beneficiaries Demographic Factors in the CMS-HCC Model Original Reason for Entitlement Code (OREC) Medicaid Disease Hierarchy Disease and Disabled Interactions End Stage Renal Disease (ESRD)

This manual chapter addresses the policies and operations related to the data collection for, calculation of, and use of risk scores in Part C and Part D payments through 2011. For detailed information on payment policies and formulas, refer to Chapter 8 for Part C payment (a chapter for Part D payment is forthcoming).

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Transcription of Medicare Managed Care Manual - CMS

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