The “Rxisk” of adjustments in 2018 ACA risk adjustment

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By Alan Vandagriff, Jason Petroske, Michael T. Hunter, Michelle Klein | 18 August 2017
The Centers for Medicare and Medicaid Services (CMS) is adding a new prescription drug category classification system to the 2018 risk adjustment model. Starting in 2018, a condition will be identified through a Hierarchical Condition Category with associated medical diagnosis codes, a prescribed medication, or both—each one affecting the final risk member score differently. This paper approximates the likely CMS mapping based on the publicly available information to date.