How to convert risk adjustment scores into dollar amounts from the Medical Expenditure Panel Survey?

Question

I want to take the 2002-2009 Risk Adjustment Scores of the Medical Expenditure Panel Survey and convert them to dollar amounts.

The documentation has a table for conversion, but since there are multiple scores in the file, I do not know which to use.

Has anyone else done this before? All I'm looking for is an equation to get a dollar risk amount. Thank you!

Answer 1

This is a complex calculation. Several factors are considered before the risk score is created, including age, original reason for entitlement, Medicaid status, and primary payer information. The data behind these include the Minimum Data Set Long Term Institutional File and the Common Medicare Environment from the Beneficiary Demographic Input File. The Medical Expenditure Panel has a query interface.

"Diagnostic Data is used in risk score calculations and is obtained from both plans and FFS providers.

• The Risk Adjustment Processing System (RAPS) Database contains the diagnostic data submitted by Medicare Advantage plans, PACE organizations, and cost plans.
• The National Medicare Utilization Database (NMUD) contains the diagnostic data submitted by fee-for-service providers.

The Risk Adjustment System (RAS) calculates risk scores for all Medicare beneficiaries." (Medicare Managed Care Manual)