RiskScorePatientDetail

Patient details in response. Risk score is calculated per patient based on patient's demographic relative factors and associated diagnosis codes. Multiple diagnosis codes and disease/disabled interactions are associated with a patient and one or more HCCs are associated with a diagnosis code.

Name	Description	Type	Additional information
requestId	This field has been changed to optional to meet the HIPAA De-Identification requirements. The order the responses come back is the same as the order the requests are received.	string	None.
demographics	Collection of the relative factors from the demographic indicators (age/sex/Medicaid/disability).	Collection of RiskScoreDemographic	Required
interactions	Collection of disease/disabled interaction.	Collection of RiskScoreInteraction	Required
diags	Collection of diagnosis response information.	Collection of RiskScoreDiagnosisDetail	Required
demographicFactor	Demographic relative factors. Adding all of the relative factors from the demographic indicators (age/sex/Medicaid/disability).	decimal number	Required
diseaseFactor	Relative factors from the disease indicators(HCCs, Interactions). Adding all of the relative factors from the disease indicators(HCCs, Interactions).	decimal number	Required
paymentCount	The Alternative Payment Condition Count (APCC) model for PY 2020 has the additional coefficient for payment HCC counts between 4 and 10,	RiskScorePaymentCount	Required
rawScore	Raw Risk Score = Demographic Relative Factors + Disease Relative Factors Sum the demographic and disease factors to determine the raw risk score. This requires adding all of the relative factors from the demographic indicators (age/sex/Medicaid/disability) and all of the relative factors from the disease indicators(HCCs, Interactions)	decimal number	Required
normalizationFactor	Payment rates rise or fall annually because CMS bases the MA payment model on the FFS model, and each year normalization factor is determined to ensure that they are doling out equivalent payments across the two programs (FFS and RAPS, FFS and EDPS). Two seprate FFS Normalization factors will be used in 2019 for the RAPS and EDPS models. The normalization factors will be 1.041 (up from 1.017) and 1.038.	decimal number	Required
normalizedScore	Normalized Risk Score = Raw Risk Score / Normalization Factor Normalize the risk score by dividing the raw risk score by the normalization factor, and then rounding to 3 decimal places. It is important to remember to round at each step, as not doing so could cause a discrepancy in the final calculation.	decimal number	Required
codingIntensityFactor	Coding intensity refers to the difference in diagnostic coding patterns between Medicare Advantage and FFS Medicare. 5.90% for the 2019 coding intensity adjustment.	decimal number	Required
adjustedScore	Risk Score with Coding Intensity Adjustment = Normalized Risk Score * (1 – Coding Intensity Factor) Apply Coding Difference Adjustment by multiplying normalized risk score times (1‐Coding Difference Adjustment) and then rounding to three(3) decimal places.	decimal number	Required