Relevant to: All Medicare Advantage Organizations, Medicare-Medicaid Plans, PACE
For CY 2023, CMS is implementing an updated ESRD model for payment to Medicare Advantage organizations that is calibrated on more recent data, using diagnoses filtered using the approach we currently use to filter encounter data records. It also incorporates improvements made to the Part C CMS-HCC model, specifically the clinical updates and revised segmentation, which accounts for the differential cost patterns of dual eligible beneficiaries.
