Implementation of risk adjustment for Medicare.
The Health Care Financing Administration (HCFA) implemented risk adjustment for Medicare capitated organizations January 2000. The risk adjustment system used, the Principal Inpatient Diagnostic Cost Group (PIPDCG) method, had to be incorporated into the payment structure mandated by the Balanced Budget Act of 1997 (BBA). This article describes how risk adjustment was integrated into the payment system within the rules of the BBA, and how fee-for-service (FFS) and health maintenance organization (HMO) data are collected and used in the determination of payment.
Ingber
M J
MJ
Office of Strategic Planning, Health Care Financing Administration, Baltimore, MD 21244-1850, USA. mingber@hcfa.gov
D000293:Adolescent; D000328:Adult; D000368:Aged; D002204:Capitation Fee / Q000706:statistics & numerical data*; D014487:Centers for Medicare and Medicaid Services, U.S.; D002648:Child; D002675:Child, Preschool; D003710:Demography; D018588:Fee-for-Service Plans; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics*; D006284:Health Plan Implementation; D006801:Humans; D007223:Infant; D007256:Information Systems; D008297:Male; D020398:Medicare Part C / Q000191:economics*; D008875:Middle Aged; D011445:Prospective Payment System; D020379:Risk Adjustment / Q000458:organization & administration*; D018511:Systems Integration; D014481:United States