HHS Notice of Benefit and Payment Parameters for 2021 Final Rule

QUESTION:

What are the HHS-HCC categories for 2021 and where can I find the risk adjustment factors? What ICD-10 codes map to an HHS-HCC for 2021?

ANSWER:

• Click here to download the ICD-10 to HHS-HCC Mappings for payment year 2021.

• Click here to download the HCC Coefficients for payment year 2021.

Links to Important Resources

Regulations and Guidance – Includes model software

• https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/index

Registration not required.

REGTAP Registration for Technical Assistance Portal

• https://www.regtap.info/

Must register for a free account to access information.

Visit ERM365 to learn more

Give the Gift of Knowledge this Holiday Season!

    Register your team today - Orlando is SOLD OUT!

   Join Us for a Day of Risk Adjustment! 

• Review the different risk adjustment models and their impact on medical practice management. 
• Discuss the impact of shifting from RAPS to EDS. What does this mean for office based claims?
• Take a deep dive into HCC Coding and clinical documentation. Review real examples to see what validates, what doesn’t, and why. Tips for engaging physicians.
• Learn how to leverage frontline staff to be successful in the world of risk adjustment and value based payments.  

     Each Attendee Will Receive:     ($130+ value)

• Color Presentation
• Clinical Documentation and Coding Guide
• HCC Quick Coder
• Laminated Coding and Documentation Tools

     Who Should Attend: 

• Medical Coders and Billers
• Providers, Managers and Frontline Staff
• CDI Specialists
• Executive Leaders
• ACO, MSO and IPA Teams
• Rural Health Centers
• Health Alliance Members
• Medicare, Medicaid and Commercial Plans

      Thursday January 25th 2018

      10:00 AM - 4:00 PM

        Symphony Presentation Center 

        2875 S Ocean Blvd, Suite 200, Palm Beach, FL 33480

           Register Now - Very Limited Seating Available

       

      Thursday, April 5th, 2018

      10:00 AM - 4:00 PM

         

        Hilton Garden Inn Tampa / Riverview

        4328 Garden Vista Dr., Riverview, FL 33578

          Register Your Team Today - Save 10% on 3 or More

       

    View additional details and download the complete agenda here

     

      https://www.ermconsultinginc.com/upcoming-events/

Exchange enrollees study by Truven Health Analytics reveals surprises

It’s only one study based on the health data of one unnamed state. But if the results of the Truven Health Analytics study are at all typical of the general U.S. population, then insurers offering coverage through health care reform exchanges should be braced for some very high utilization numbers by an unexpectedly older consumer population.

Truven said it used the data provided by “a large health plan to investigate demographics, risk, financial factors, and utilization patterns in the exchange population of its state.” The results of the analysis suggest that some of the basic predictions about those who would purchase coverage through an exchange might have been way off. Truven did not identify either the state or the health plan.

Report findings include:

• Exchange Attracted Older Enrollees: The average enrollee age in the state that was chosen for the study was 46 for the exchange population and 44 for those off the exchanges. Only one plan – the catastrophic level – had an average age under 44 (31 years).
• More Admissions, ER Visits: Exchange enrollees had a whopping 39 percent more admissions and 64 percent more emergency department visits per 1,000 enrollees than non-exchange insureds. Medical and prescription drug utilization increased as the plan design level increased.
• Higher Rate of Chronic Conditions: Exchange enrollees had 44 percent more instances of congestive heart failure and 39 percent more diabetes cases in exchange members. Additionally, exchange enrollees experienced more seizure disorders and convulsions (26 percent), asthma (21 percent), and major depressive disorder (8 percent) versus non-exchange counterparts.
• Silver Plans Dominate Exchanges: Silver plans (including both standard silver and cost-sharing reduction plans) are the preferred plan of choice for exchange enrollees, with an 82 percent market share. Bronze enrollees accounted for just 6 percent, while platinum had 4 percent of the market.
“Now, more than ever, health plan leaders need to understand details about their unique populations to create appropriate product strategies and plan designs for the future,” said Barbara Graovac, senior vice president at Truven Health Analytics. “With this snapshot of one state’s exchange population, it becomes clear how profound the differences between an exchange and off-exchange health plan population can be, and, how different reality is from initial predictions.”

http://www.benefitspro.com/2015/05/19/exchange-enrollees-study-by-truven-health-analytic