Risk adjustment is a process to account for differences in the mix of certain pa

Risk adjustment is a process to account for differences in the mix of certain patient attributes across healthcare settings, plans, practitioners and other groupings of interest. Development of a credible and accepted model of risk is a complex calculus especially when such models are used for public reporting and for setting payments.
Though various risk models exist, the
CMS Hierarchical Condition Category (CMS-HCC) has been successfully applied to the Medicare population. The success of this model in predicting future healthcare cost and utilization prompted the development of the HHS-HCC model which is applied to payers and plans as part of the Affordable Care Act. Correct assumption of risk by payers and plans is important to ensure appropriate transfer of dollars to plans that have assumed greater risk within their patient population.
Produce a 4 page report that compares and contrasts the Medicare Advantage Risk Adjustment model with the ACA Risk Adjustment model. Your report should also include an Appendix with the two HCC list and their corresponding ICD code mappings for each model.

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