Research Article: Drivers of Individual and Regional Variation in CMS Hierarchical Condition Categories Among Florida Beneficiaries
Introduction:
Hierarchical Condition Categories (HCCs) are used by the Centers for Medicare and Medicaid Services (CMS) as part of a risk-adjustment model that identifies individuals with severe acute or chronic conditions and assigns them a corresponding risk score. The CMS HCC-based risk adjustment is prospective, whereby diagnoses in one year are used to predict costs in the subsequent year. The statistical model accounts for age, sex, Medicaid eligibility, and diagnoses. Diagnoses are grouped into condition categories based…
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