CMS Risk Adjustments


CMS research files do not include beneficiary risk adjustment scores.  However, CMS does provide the programming code and instructions to calculate the three risk adjustments that CMS uses as the basis for managed care payment.

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Often, researchers want to compare an individual to a similar group as a way to predict a certain outcome. One way to make the comparison is to calculate a risk adjustment score for each person based on factors such as age, gender and medical condition. The individual’s calculated risk score is compared to the average and used to predict an outcome (i.e. health care costs).

CMS uses risk adjustment as the basis for calculating managed care payment.  CMS provides programming code and descriptions for their risk adjustments on the CMS Risk Adjustment website.

  • Hierarchical condition category (HCC)
  • RxHCC
  • End Stage Renal Disease

Disclaimer:  ResDAC provides this information as a resource. ResDAC did not create the programming code and cannot provide technical support for it.