Common use of Risk Adjustment Methodology Clause in Contracts

Risk Adjustment Methodology. Medicare Parts A/B: The Medicare Parts A/B Component will be risk adjusted based on the risk profile of each Enrollee. Except as specified in Section 4.3.5.1.1, the existing Medicare Advantage CMS‑HCC and CMS‑HCC ESRD risk adjustment methodology will be used for the Demonstration. Coding Intensity Adjustment Factor CMS will calculate calendar year 2013 rates as if the coding intensity adjustment factor were not applied, to reflect the fact that virtually all Enrollees were receiving care in FFS Medicare and thus there should be no coding pattern differences for which to adjust. Operationally CMS will still apply the coding intensity adjustment factor to the risk scores but will increase the Medicare A/B baseline for non‑ESRD beneficiaries and beneficiaries with an ESRD status of functioning graft, to offset this.