Risk Adjustment (RA) FAQ
Guidance for FAQ regarding Risk Adjustment Operations and Policy
Program Area: Risk Adjustment (RA)
Question: Regarding the Risk Adjustment (RA) calculation for people who are in the hospital at the end of the year and are not discharged until after the new year, do those diagnoses go towards the following year?
Answer: Yes, the diagnoses would be applied to the following year for calculation of enrollee risk scores and Plan Liability Risk Score (PLRS). In the event that the enrollee has zero days of enrollment in the following year, a system-generated cross-year enrollment period will be created to ensure inclusion of those diagnoses in the following year. For more information, please refer to the 'Risk Adjustment Cross-Year Claims (DDC 01/19/16)' in the REGTAP Library.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: January 29, 2019
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