The Risk Score Files are created from the final CMS risk adjustment model outputs for a payment year. These risk scores are used to adjust CMS payments to Medicare Advantage (Part C) plans to account for differences in relative costs among plan enrollees. At this time, only Payment Year (PY)14 risk score files are available for research use.
Please see the Medicare Managed Care Manual, Chapter 7 for a discussion of risk adjustment in the Medicare Advantage program.
The PY14 Risk Score Files includes six segments: a base file, four files with outputs from Part C models and one for Part D model outputs. All files can be linked to other CCW files via the Bene_ID.
What does this file include? (variable highlights)
PY14 Base file:
- Part C monthly risk payment scores
- Part C monthly model segment codes
- Part D model risk payment scores
- Part D monthly model segment codes
- Part C monthly institutional indicators
- Part C community and institutional non-monthly model payment scores
- Part D non-monthly model payment scores
- Model Medicaid flag
PY14 Model Output Segments:
- Model output raw risk scores from 4 Part C model versions, one for ESRD
- Model output raw risk score from 1 Part D model version
- Model-specific Hierarchal Condition Codes (HCCs)
- Model-specific disability information
- ESRD model-specific information
- Part D model output including drug HCCs (RXHCCs)