rxc_hier

A dataset used to apply the risk adjustment Rx condition category
hierarchies. The HHS risk model uses hierarchical condition categories.
This means that when an individual has e.g. RXC 6 (Insulin), they do not also
get the risk score for RXC 7 (Anti-Diabetic Agents, Except Insulin...).

datasets

Datasets from most recent CCIIO DIY entry
in a tidy format. These support the Centers for Medicare and Medicaid
Services' (CMS) risk adjustment Do-It-Yourself (DIY) process, which allows
health insurance issuers to calculate member risk profiles under the Health
and Human Services-Hierarchical Condition Categories (HHS-HCC) regression
model. This regression model is used to calculate risk adjustment transfers.
Risk adjustment is a selection mitigation program implemented under the
Patient Protection and Affordable Care Act (ACA or Obamacare) in the USA.
Under the ACA, health insurance issuers submit claims data to CMS	in order
for CMS to calculate a risk score under the HHS-HCC regression model.
However, CMS does not inform issuers of their average risk score until after
the data submission deadline. These data sets can be used by issuers to
calculate their average risk score mid-year. More information about risk
adjustment and the HHS-HCC model can be found here:
<https://www.cms.gov/mmrr/Articles/A2014/MMRR2014_004_03_a03.html>.

Ethan Brockmann

edgedata

Datasets that Support the EDGE Server DIY Logic

rxc_hier function

An object of class <code>tbl_df</code> (inherits from <code>tbl</code>, <code>data.frame</code>) with
1 rows and 3 columns<dl class="dl-horizontal">
<dt>rxc</dt><dd>Rx condition code without leading zeroes</dd>
<dt>desc</dt><dd>Rx condition code description</dd>
<dt>set_0</dt><dd>Rx condition code that falls below <code>rxc</code> on the hierarchy
No leading zeroes</dd>
</dl>

Format

Rx Condition Hierarchies - Table 11 — rxc_hier

An object of class <code>tbl_df</code> (inherits from <code>tbl</code>, <code>data.frame</code>) with
1 rows and 3 columns<dl class='dl-horizontal'>
<dt>rxc</dt><dd>Rx condition code without leading zeroes</dd>
<dt>desc</dt><dd>Rx condition code description</dd>
<dt>set_0</dt><dd>Rx condition code that falls below <code>rxc</code> on the hierarchy
No leading zeroes</dd>
</dl>

rxc_hier: Rx Condition Hierarchies - Table 11

Description

Usage

Arguments

Format

See Also