Contact Us
Sign In / Sign Up for FREE
Go to advanced search...

Hierarchical condition category and Centers for Medicare & Medicaid Services model - Research Paper Example

Comments (1) Cite this document
This research paper will mainly focus on the Hierarchical condition category and Centers for Medicare & Medicaid Services model. It will go ahead and give its principles, organization of the model and the segments used in this model. In the paper, there is a diagram to show the versions of this model. …
Download full paperFile format: .doc, available for editing
GRAB THE BEST PAPER93.8% of users find it useful
Hierarchical condition category and Centers for Medicare & Medicaid Services model
Read TextPreview

Extract of sample "Hierarchical condition category and Centers for Medicare & Medicaid Services model"

Download file to see previous pages The paper tells that one of the methods used in amending health plans capitation payments is risk amendment. This can be either lower or higher to explain the differences in the health costs expected for individuals. Insurers in establishing their revenue necessities are using various factors and medical expenditure trends. The models of adjusting risks used, determine the monthly capitation fee for every enrollee. The expectations of these models are supposed to be accurate. The model for Hierarchical condition category uses mainly demographic information such as sex and age. On the other hand, it uses medical condition profiles in order to calculate the following year’s expenditures in Medicare. It is standardized on the fee for service population because it gives full and complete data on Medicare claims unlike the Medicare advantage population. While developing this model, establishing diagnosis codes are to be taken account of; their grouping and how these groupings work together for the purposes of risk adjustments was a vital step. The first principle states that groups of diagnostics are supposed to be meaningful in a clinical manner. Every diagnostic group is part of the International Classification of Diseases, Ninth Revision, Clinical Modification codes. The codes issued are supposed to relate with a medical condition or a specified disease that identifies the category. The conditions issued are supposed to be adequately specified in a clinical way in order to diminish the discretionary coding or gaming opportunities. The face authority of the system of classification to the clinicians is improved by the clinical meaningfulness. On the other hand, the clinical meaningfulness improves superiority, monitoring disease organization utility and interpretability. The second principle is the prediction of the medical expenditures by the diagnostic groups. The diagnoses in the similar Hierarchical condition category are supposed to be homogenous with effects respect on the future and current year’s costs. The third principle is the diagnostic groups, those that are assumed to have an effect on payments are supposed to be adequate in their illustration size for correct expenditure estimates. These diagnostics used in payment establishment are supposed to have sufficient illustration sizes in the data sets accessible. The fourth principle is the use of hierarchies in creating a clinical profile of a person (American Academy of Actuaries, 2010). This is to distinguish the level of illness of a given person while the disease effects are accumulating. These disease effects are expected to increase the medical care costs because every medical issue adds up to a disease trouble of an individual. Disease conditions that are related in one way or the other are supposed to be hierarchically treated. The fifth principle is the encouragement of diagnostic categorization in encouraging detailed coding. Diagnostic codes that are assumed indistinct, are supposed to be classified with less severe categories of diagnostics in order to give incentives for a diagnostic coding that is specific. The sixth principle is the classification of diagnostics that are not supposed to be issued with any coding creation rewards. It is not supposed to determine an immense burden of ...Download file to see next pagesRead More
Cite this document
  • APA
  • MLA
(“Hierarchical condition category and Centers for Medicare & Medicaid Research Paper”, n.d.)
Retrieved from
(Hierarchical Condition Category and Centers for Medicare & Medicaid Research Paper)
“Hierarchical Condition Category and Centers for Medicare & Medicaid Research Paper”, n.d.
  • Cited: 0 times
Comments (1)
Click to create a comment or rate a document
ggislason added comment 1 year ago
Student rated this paper as
Excellent paper! Used it to complete an assignment for a health sciences & medicine course. It was easy as ABC, for the first time in my life.

CHECK THESE SAMPLES OF Hierarchical condition category and Centers for Medicare & Medicaid Services model

Service Management in Financial Services

 Measurement of quality is the result of the services provided to the customer with a prompt response based on the requirements and expectations. Quality of various processes must be managed so as to provide the customer with consistent, accurate and timely results. These results must be of high quality because various other factors pertaining to a business deal are dependent on them. Quality assures the customer of an appropriate service that includes an error-free transaction, access to accurate data pertaining to the specific schemes and services, transfer of credits, changes concerned with the membership and account details and an undoubted trust that helps in attaining the services time and again.

Financial se...
11 Pages(2750 words)Case Study

Black and Scholes Model

For this reason, it has been supported by Leslie (1997, 4) that “many discussions in the literature get bogged down in the mathematics of Black Scholes valuation when they go beyond the conceptual level; however managers dont need to be deeply conversant with the calculation techniques of real-option valuation”. The particular model can be found in the Appendix section. It should be noticed in any case the Black-Scholes model has originally developed for the pricing of options. However, its potential use in different sectors at the next stage cannot be rejected. As for the potential use of the specific model in the energy sector, this could be considered as rather difficult to be completed mostly because this model wou...
11 Pages(2750 words)Assignment

Why Has the Category of Youth Been so Notoriously Difficult to Define

Youth is a period when they have to acquire new tools to become part of the workforce and assume responsibilities in the world. Youth can no longer be defined in terms of formal education or on the basis of age. They are a heterogeneous group consistently unstable and undergoing the process of evolution. The concept of youth has changed as modern societies have evolved. It is the transition from childhood to adulthood and the youth are tossed from one state to another either through the condition of their own mind or by the norms of the society. Ironically, this is precisely the age when they need the right guidance to channel their energies in the right direction. While they are full of vigor and energy they also undergo an inner...
7 Pages(1750 words)Term Paper

Lockheed Martin as a Model for Ethics in an Organization

Lockheed Martin (LM) had been focusing on petty issues like how to respond to a chain letter from the supervisor or how to deal with an employee who steals his child’s school supplies from the company (Guenther, 2000). They did not allow whistle blowing and there no ethical codes of conduct laid down. In 1997 McDonnell Douglas hired an engineer away from LM who carried with him all proprietary documents. Later that year McDonnell Douglas merged with Boeing, rivals to LM and in 2005 LM and Boeing decided to merge their space-rocket business and came into agreement to drop their litigation over the stolen rocket-contract information (Gates & Mundy, 2006). They could be barred from defense contracts and denied export licens...
6 Pages(1500 words)Term Paper

ITT Cleaning Services: A Business Profile

In a competitive industry inundated with corporate cleaning giants, ITT has managed to capture the attention of the busy London consumer, appealing to human psychology as a means to promote convenience as priority number one. 

ITT appears to understand the consumer profile, perhaps drawing on Abraham Maslow’s renowned theory of human motivation, so as to appeal to their physiological needs for stress reduction when attempting to juggle business, family, and the responsibilities of household maintenance. Unlike their competitors, which routinely focus on value-driven strategies and product upgrades through R & D investments, ITT has found a connection by sympathizing with the hectic consumer and providing...
12 Pages(3000 words)Case Study

The Role of Web Services in E-Commerce

Web services share business logic, data, and processes through a programmatic interface across a network (Kaye, 2003).

This becomes a platform for business that takes place across the internet in ways that were previously unimagined. E-commerce is much like regular commerce except that the markets have expanded and the competition has become global instead of local or even regional. Web services allow people from across the world to engage in business and the few barriers which remain for truly global commerce are being removed with automated language translators and website optimization techniques that allow users from different locations to view the web as they prefer to view it. All of these developments are takin...

8 Pages(2000 words)Coursework

HR Model That Can Measure if It Adds Value

There has been a change of approach in the way that labor is reviewed in the organization and the modern perception emphasizes viewing labor as an investment and not as a commodity or resources. In this regard, labors have started to be seen as a made of creative and innovative social being who is able to give the organization a competitive edge. (Michael 2006, p. 42)
The term human resource has been changing to broader management and the concept of human capital has been applied more often in place of human resources. Therefore the modern perception of human labor has been changing the way organization have been handling their human capital to a more liberalized way. It has been realized that having a competitive workforce c...
13 Pages(3250 words)Assignment

Vaginal Adenosis Condition

Adenosis is considered a benign abnormality rather than a disease. What is significant about this condition though is that it is usually a precursor to another, a more severe condition called vaginal adenocarcinoma, a kind of vaginal cancer. Vaginal adenosis is found to be linked to the use of a drug called diethylstilbestrol (DES) used to be prescribed to women in the 1940s for the purpose of, among others, preventing miscarriages (Woolf 1998). The vaginal adenosis condition is manifested in the vaginal walls by the presence of glandular structures. These glandular structures along the vaginal walls consist of mucous-producing epithelium resulting from an improper replacement of müllerian structures by squamous epithelium. O...
8 Pages(2000 words)Term Paper

Building Engineering Services and Analysis of Core Systems

Finally, we will conduct an in-depth analysis of the heating and insulation systems available in modern homes and propose a strategy to optimize the energy consumption and maximize customer comfort.

Building Service Engineers are usually mechanical or electrical engineers, who do not necessarily have a degree in Building Services Engineering. They start contributing to inputs before the building construction commences. Their assessment starts with researching the suitability of the building site for construction and also foreseeing the provisions to connect services to supply lines. Based on this analysis, they conduct discussions with the client, architects and structural engineers to concur on an installation design t...
13 Pages(3250 words)Report

A democratic political system is an essential condition for sustained economic progress. Discuss

What is now clear is that democracy is superior when it comes to countries that have a heterogeneous mix of people and cultures since it is imperative that all sections of society be carried along if the process of economic development has to succeed. In case this does not happen, the concerned country faces the risk of social unrest and the inability of the government to carry all the citizens along with the process of economic development.

If we look at some of the competing ideologies of the 20th century. Communism was the dominant ideology of many countries of the eastern bloc. The basic tenet of communism is the absence of private profit and state ownership of the factors of production. This means that all workers...
11 Pages(2750 words)Term Paper
sponsored ads
We use cookies to create the best experience for you. Keep on browsing if you are OK with that, or find out how to manage cookies.

Let us find you another Research Paper on topic Hierarchical condition category and Centers for Medicare & Medicaid Services model for FREE!

Contact Us