On April 1 st, the Centers for Medicare & Medicaid Services (“CMS”) announced its Medicare Advantage (“MA”) Capitation Rates and Part C and Part D Payment Policies for Calendar Year (“CY”) 2025. This ...

Among other provisions, the Rate Announcement includes the following updates: MA Payment Changes/Growth Rates: The effective growth rate for 2025 MA non-end-stage renal disease (ESRD) rates is 2.33%.

Accurate risk adjustment isn’t just a box to check; it’s now a strategic lever. Hierarchical Condition Category (HCC) coding underpins risk scores that drive Medicare Advantage and other value-based ...

One of the most significant changes for 2024 is the introduction of version 28 of the Risk Adjustment Model, increasing the number of HCCs from 86 to 115, changing the name and numbering of HCCs, the ...