Type: | Package |
Title: | Datasets that Support the EDGE Server DIY Logic |
Version: | 0.2.0 |
Description: | 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. |
License: | GPL-3 |
Encoding: | UTF-8 |
LazyData: | true |
RoxygenNote: | 7.1.1 |
Depends: | R (≥ 4.0) |
NeedsCompilation: | no |
Packaged: | 2021-02-26 20:30:30 UTC; Ethan's Laptop |
Author: | Ethan Brockmann [aut, cre, cph] |
Maintainer: | Ethan Brockmann <ethanbrockmann@gmail.com> |
Repository: | CRAN |
Date/Publication: | 2021-02-26 22:00:09 UTC |
Adult Demographic Factors - Table 9
Description
A dataset containing the adult model demographic factors for the risk adjustment model. Demographics vary by age (groupings) and sex.
Usage
adult_demo
Format
An object of class tbl_df
(inherits from tbl
, data.frame
) with
18 rows and 9 columns
- used
Whether or not the category is used in the RA model
- plat, gold, silver, bronze, cat
Demographic risk score for each metal level
- sex
Male/Female demographic category
- age_min, age_max
Maximum and minimum age for each risk score
Source
Data import and cleaning at: https://github.com/EeethB/edgedata/tree/main/data-raw
See Also
Other factors:
adult_enroll_dur
,
adult_group
,
adult_hcc
,
adult_interaction
,
adult_rxc_hcc_inter
,
adult_rxc
,
child_demo
,
child_group
,
child_hcc
,
infant_demo
,
infant_mat_sev
Adult Enrollment Duration Factors - Table 9
Description
A dataset containing the adult model enrollment duration factors for the risk adjustment model. Risk score is increased for members with less than 12 months' duration due to risk that is present but not accounted for in diagnoses and prescriptions during the enrollment window.
Usage
adult_enroll_dur
Format
An object of class tbl_df
(inherits from tbl
, data.frame
) with
11 rows and 7 columns
- used
Whether or not the category is used in the RA model
- plat, gold, silver, bronze, cat
Enrollment duration risk score for each metal level
- months
Number of enrollment months for each risk score
Source
Data import and cleaning at: https://github.com/EeethB/edgedata/tree/main/data-raw
See Also
Other factors:
adult_demo
,
adult_group
,
adult_hcc
,
adult_interaction
,
adult_rxc_hcc_inter
,
adult_rxc
,
child_demo
,
child_group
,
child_hcc
,
infant_demo
,
infant_mat_sev
Adult HCC Grouping Factors - Table 9
Description
A dataset containing the adult model HCC grouping factors for the risk adjustment model. Some condition categories have been grouped together, so that any number of HCCs within that group are zeroed out and replaced by the group.
Usage
adult_group
Format
An object of class tbl_df
(inherits from tbl
, data.frame
) with
17 rows and 7 columns
- group
Group label for risk scores
- used
Whether or not the category is used in the RA model
- plat, gold, silver, bronze, cat
HCC grouping risk score for each metal level
Source
Data import and cleaning at: https://github.com/EeethB/edgedata/tree/main/data-raw
See Also
Other factors:
adult_demo
,
adult_enroll_dur
,
adult_hcc
,
adult_interaction
,
adult_rxc_hcc_inter
,
adult_rxc
,
child_demo
,
child_group
,
child_hcc
,
infant_demo
,
infant_mat_sev
Other HCC tables:
adult_hcc
,
adult_interaction
,
adult_rxc_hcc_inter
,
cc_hier
,
child_group
,
child_hcc
,
cpt_hcpcs
,
icd_cc
Adult HCC Factors - Table 9
Description
A dataset containing the adult model HCC factors for the risk adjustment
model. Condition categories (CCs) are triggered by ICD-10 codes (See
icd_cc
), and a hierarchy is then applied (See
cc_hier
), creating hierarchical condition categories (HCCs).
Usage
adult_hcc
Format
An object of class tbl_df
(inherits from tbl
, data.frame
) with
128 rows and 7 columns
- used
Whether or not the category is used in the RA model
- plat, gold, silver, bronze, cat
HCC grouping risk score for each metal level
- hcc
HCC label for risk scores (Includes leading zeroes)
Source
Data import and cleaning at: https://github.com/EeethB/edgedata/tree/main/data-raw
See Also
Other factors:
adult_demo
,
adult_enroll_dur
,
adult_group
,
adult_interaction
,
adult_rxc_hcc_inter
,
adult_rxc
,
child_demo
,
child_group
,
child_hcc
,
infant_demo
,
infant_mat_sev
Other HCC tables:
adult_group
,
adult_interaction
,
adult_rxc_hcc_inter
,
cc_hier
,
child_group
,
child_hcc
,
cpt_hcpcs
,
icd_cc
Adult Interaction Factors - Table 9
Description
A dataset containing the adult model interaction factors for the risk adjustment model. Certain HCCs are considered "high risk" HCCs, and when one of these high risk HCCs interacts with certain other HCCs, an additional interaction term is added to the risk score.
Usage
adult_interaction
Format
An object of class tbl_df
(inherits from tbl
, data.frame
) with
2 rows and 7 columns
- int_group
Interaction group (M/H)
- used
Whether or not the category is used in the RA model
- plat, gold, silver, bronze, cat
HCC grouping risk score for each metal level
Source
Data import and cleaning at: https://github.com/EeethB/edgedata/tree/main/data-raw
See Also
Other factors:
adult_demo
,
adult_enroll_dur
,
adult_group
,
adult_hcc
,
adult_rxc_hcc_inter
,
adult_rxc
,
child_demo
,
child_group
,
child_hcc
,
infant_demo
,
infant_mat_sev
Other HCC tables:
adult_group
,
adult_hcc
,
adult_rxc_hcc_inter
,
cc_hier
,
child_group
,
child_hcc
,
cpt_hcpcs
,
icd_cc
Adult Rx Condition Factors - Table 9
Description
A dataset containing the adult model prescription drug category (RXC)
factors for the risk adjustment model. Rx condition categories are
triggered by NDC codes (See ndc_rxc
) or HCPCS codes (See
hcpcs_rxc
), and a hierarchy is then applied (See
rxc_hier
).
Usage
adult_rxc
Format
An object of class tbl_df
(inherits from tbl
, data.frame
) with
10 rows and 7 columns
- used
Whether or not the category is used in the RA model
- plat, gold, silver, bronze, cat
HCC grouping risk score for each metal level
- rxc
RXC label for risk scores (Includes leading zeroes)
Source
Data import and cleaning at: https://github.com/EeethB/edgedata/tree/main/data-raw
See Also
Other factors:
adult_demo
,
adult_enroll_dur
,
adult_group
,
adult_hcc
,
adult_interaction
,
adult_rxc_hcc_inter
,
child_demo
,
child_group
,
child_hcc
,
infant_demo
,
infant_mat_sev
Other RXC tables:
adult_rxc_hcc_inter
,
hcpcs_rxc
,
ndc_rxc
,
rxc_hier
Adult RXC/HCC Interaction Factors - Table 9
Description
A dataset containing the adult model RXC/HCC interaction factors for the risk adjustment model. Some HCCs have built-in risk for the associated drugs, so if a member has both the diagnosis and the drug, their risk is overstated. Other drugs combined with conditions indicate a greater severity than either the drug or the condition alone, so risk is understated. The RXC/HCC interaction factors make these adjustments.
Usage
adult_rxc_hcc_inter
Format
An object of class tbl_df
(inherits from tbl
, data.frame
) with
32 rows and 8 columns
- used
Whether or not the category is used in the RA model
- plat, gold, silver, bronze, cat
HCC grouping risk score for each metal level
- rxc
RXC label for risk scores (Includes leading zeroes)
- hcc
HCC label for risk scores (Includes leading zeroes)
Source
Data import and cleaning at: https://github.com/EeethB/edgedata/tree/main/data-raw
See Also
Other factors:
adult_demo
,
adult_enroll_dur
,
adult_group
,
adult_hcc
,
adult_interaction
,
adult_rxc
,
child_demo
,
child_group
,
child_hcc
,
infant_demo
,
infant_mat_sev
Other HCC tables:
adult_group
,
adult_hcc
,
adult_interaction
,
cc_hier
,
child_group
,
child_hcc
,
cpt_hcpcs
,
icd_cc
Other RXC tables:
adult_rxc
,
hcpcs_rxc
,
ndc_rxc
,
rxc_hier
Condition Category Hierarchies - Table 4
Description
A dataset used to apply the risk adjustment condition category hierarchies. The HHS-Hcc risk model uses hierarchical condition categories. This means that when an individual has e.g. HCC 8 (Metastatic Cancer), they do not also get the risk score for less serious cancer categories.
Usage
cc_hier
Format
An object of class tbl_df
(inherits from tbl
, data.frame
) with
149 rows and 3 columns
- cc
Condition category code without leading zeroes
- desc
Condition category description
- set_0
Condition category that falls below
cc
on the hierarchy. No leading zeroes
Source
Data import and cleaning at: https://github.com/EeethB/edgedata/tree/main/data-raw
See Also
Other HCC tables:
adult_group
,
adult_hcc
,
adult_interaction
,
adult_rxc_hcc_inter
,
child_group
,
child_hcc
,
cpt_hcpcs
,
icd_cc
HCC to interaction group "H" mapping - Table 6
Description
A dataset containing the mapping from HCC to interaction group "H".
Usage
cc_int_h
Format
An object of class tbl_df
(inherits from tbl
, data.frame
) with
9 rows and 3 columns
- cc
Hierarchical condition category (Currently includes some G*)
- var
Variable mapped to (int_group_h)
- desc
Short description of the variable
Details
Interaction group H (high?) takes priority over interaction group M (moderate?). If a member qualifies for group H, they should not get credit for group M.
Source
Data import and cleaning at: https://github.com/EeethB/edgedata/tree/main/data-raw
See Also
Other Severe interaction tables:
cc_int_m
,
cc_severe
HCC to interaction group "M" mapping - Table 6
Description
A dataset containing the mapping from HCC to interaction group "M".
Usage
cc_int_m
Format
An object of class tbl_df
(inherits from tbl
, data.frame
) with
7 rows and 3 columns
- cc
Hierarchical condition category (Currently includes some G*)
- var
Variable mapped to (int_group_m)
- desc
Short description of the variable
Details
Interaction group H (high?) takes priority over interaction group M (moderate?). If a member qualifies for group H, they should not get credit for group M.
Source
Data import and cleaning at: https://github.com/EeethB/edgedata/tree/main/data-raw
See Also
Other Severe interaction tables:
cc_int_h
,
cc_severe
HCC to severity group mapping - Table 6
Description
A dataset containing the mapping from HCC to severe status.
Usage
cc_severe
Format
An object of class tbl_df
(inherits from tbl
, data.frame
) with
8 rows and 3 columns
- cc
Hierarchical condition category (Currently includes some G*)
- var
Variable mapped to (severe_v3)
- desc
Short description of the variable
Source
Data import and cleaning at: https://github.com/EeethB/edgedata/tree/main/data-raw
See Also
Other Severe interaction tables:
cc_int_h
,
cc_int_m
Child Demographic Factors - Table 9
Description
A dataset containing the child model demographic factors for the risk adjustment model. Demographics vary by age (groupings) and sex.
Usage
child_demo
Format
An object of class tbl_df
(inherits from tbl
, data.frame
) with
8 rows and 9 columns
- used
Whether or not the category is used in the RA model
- plat, gold, silver, bronze, cat
Demographic risk score for each metal level
- sex
Male/Female demographic category
- age_min, age_max
Maximum and minimum age for each risk score
Source
Data import and cleaning at: https://github.com/EeethB/edgedata/tree/main/data-raw
See Also
Other factors:
adult_demo
,
adult_enroll_dur
,
adult_group
,
adult_hcc
,
adult_interaction
,
adult_rxc_hcc_inter
,
adult_rxc
,
child_group
,
child_hcc
,
infant_demo
,
infant_mat_sev
Child HCC Grouping Factors - Table 9
Description
A dataset containing the child model HCC grouping factors for the risk adjustment model. Some condition categories have been grouped together, so that any number of HCCs within that group are zeroed out and replaced by the group.
Usage
child_group
Format
An object of class tbl_df
(inherits from tbl
, data.frame
) with
17 rows and 7 columns
- group
Group label for risk scores
- used
Whether or not the category is used in the RA model
- plat, gold, silver, bronze, cat
HCC grouping risk score for each metal level
Source
Data import and cleaning at: https://github.com/EeethB/edgedata/tree/main/data-raw
See Also
Other factors:
adult_demo
,
adult_enroll_dur
,
adult_group
,
adult_hcc
,
adult_interaction
,
adult_rxc_hcc_inter
,
adult_rxc
,
child_demo
,
child_hcc
,
infant_demo
,
infant_mat_sev
Other HCC tables:
adult_group
,
adult_hcc
,
adult_interaction
,
adult_rxc_hcc_inter
,
cc_hier
,
child_hcc
,
cpt_hcpcs
,
icd_cc
Child HCC Factors - Table 9
Description
A dataset containing the child model HCC factors for the risk adjustment
model. Condition categories (CCs) are triggered by ICD-10 codes (See
icd_cc
), and a hierarchy is then applied (See
cc_hier
), creating hierarchical condition categories (HCCs).
Usage
child_hcc
Format
An object of class tbl_df
(inherits from tbl
, data.frame
) with
128 rows and 7 columns
- used
Whether or not the category is used in the RA model
- plat, gold, silver, bronze, cat
HCC grouping risk score for each metal level
- hcc
HCC label for risk scores (Includes leading zeroes)
Source
Data import and cleaning at: https://github.com/EeethB/edgedata/tree/main/data-raw
See Also
Other factors:
adult_demo
,
adult_enroll_dur
,
adult_group
,
adult_hcc
,
adult_interaction
,
adult_rxc_hcc_inter
,
adult_rxc
,
child_demo
,
child_group
,
infant_demo
,
infant_mat_sev
Other HCC tables:
adult_group
,
adult_hcc
,
adult_interaction
,
adult_rxc_hcc_inter
,
cc_hier
,
child_group
,
cpt_hcpcs
,
icd_cc
RA-eligible CPT and HCPCS - Table 2
Description
A dataset containing the Current Procedural Terminology (CPT) and Health Care Procedure Coding System (HCPCS) codes that determine if a claim is eligible for risk adjustment.
Usage
cpt_hcpcs
Format
An object of class tbl_df
(inherits from tbl
, data.frame
) with
6557 rows and 8 columns
- code
CPT/HCPCS code
- desc
Short description of the code
- prior
Whether or not the code was valid in the prior benefit year
- curr
Whether or not the code is valid in the current benefit year
- footnote
Any footnotes included in the CMS DIY file
Details
Risk adjustment requires that claims be face-to-face to count in the HHS-HCC model. The codes in this dataset denote a face-to-face procedure, so if one of these codes is found anywhere on a claim, it counts for risk adjustment.
Source
Data import and cleaning at: https://github.com/EeethB/edgedata/tree/main/data-raw
See Also
Other HCC tables:
adult_group
,
adult_hcc
,
adult_interaction
,
adult_rxc_hcc_inter
,
cc_hier
,
child_group
,
child_hcc
,
icd_cc
HCPCS to Rx Condition Crosswalk - Table 10b
Description
A dataset containing the HCPCS to Rx condition mappings.
Usage
hcpcs_rxc
Format
An object of class tbl_df
(inherits from tbl
, data.frame
) with
43 rows and 3 columns
- rxc
Rx condition number without leading zeroes
- desc
Rx condition description
- ndc
HCPCS code that maps to
rxc
Details
HCPCS codes create a system for identifying drugs given in a medical setting. But since there are so many drugs, and they very specific, the HHS-HCC model groups similar drugs into broader Rx condition categories.
Source
Data import and cleaning at: https://github.com/EeethB/edgedata/tree/main/data-raw
See Also
Other crosswalks:
icd_cc
,
ndc_rxc
Other RXC tables:
adult_rxc_hcc_inter
,
adult_rxc
,
ndc_rxc
,
rxc_hier
ICD to Condition Category Crosswalk - Table 3
Description
A dataset containing the ICD-10 to condition category mappings.
Usage
icd_cc
Format
An object of class tbl_df
(inherits from tbl
, data.frame
) with
8528 rows and 11 columns
- icd
ICD-10 code
- cc
Risk adjustment condition category
- class
It's not yet clear how this is used
- eff_date
Effective date of ICD code
- term_date
Term date of ICD code
- sex
Male/Female specification for ICD code (Risk adjustment currently only supports male and female)
- sex_num
Numeric sex encoding (1/M and 2/F)
- model_num
Number corresponding to model: 0 = newborn, 1 = pediatric 2 = maternity, 3 = adult
- model
Which regression model the age/sex filters apply to - Includes maternity, which is not used in actual score calculations
- age_min
Minimum age for a given diagnosis code
- age_max
Maximum age for a given diagnosis code
Details
The ICD-10 system is a vast diagnosis coding system in healthcare. But since there are so many diagnoses, and they very specific, the HHS-HCC model groups similar codes into broader condition categories. Additionally, some diagnoses can only apply to one sex or the other, or to a particular age range.
Source
Data import and cleaning at: https://github.com/EeethB/edgedata/tree/main/data-raw
See Also
Other crosswalks:
hcpcs_rxc
,
ndc_rxc
Other HCC tables:
adult_group
,
adult_hcc
,
adult_interaction
,
adult_rxc_hcc_inter
,
cc_hier
,
child_group
,
child_hcc
,
cpt_hcpcs
Infant Demographic Factors - Table 9
Description
A dataset containing the infant model demographic factors for the risk adjustment model. Demographics vary by age and sex.
Usage
infant_demo
Format
An object of class tbl_df
(inherits from tbl
, data.frame
) with
2 rows and 8 columns
- used
Whether or not the category is used in the RA model
- plat, gold, silver, bronze, cat
Demographic risk score for each metal level
- age
Age for each risk score
- sex
Male/Female demographic category
Source
Data import and cleaning at: https://github.com/EeethB/edgedata/tree/main/data-raw
See Also
Other factors:
adult_demo
,
adult_enroll_dur
,
adult_group
,
adult_hcc
,
adult_interaction
,
adult_rxc_hcc_inter
,
adult_rxc
,
child_demo
,
child_group
,
child_hcc
,
infant_mat_sev
Infant Maturity/Severity Factors - Table 9
Description
A dataset containing the infant model maturity/severity factors for the risk adjustment model. Risk scores are done a little differently in the infant model. Instead of grouping/applying a hierarchy to condition categories, infants have all conditions grouped into 5 severity levels (1-5). They also get a maturity level which corresponds to weeks of gestation at which they were born. There is also a maturity category for age 1.
Usage
infant_mat_sev
Format
An object of class tbl_df
(inherits from tbl
, data.frame
) with
25 rows and 8 columns
- mat
Infant maturity level. Can be extremely immature, immature, premature multiples, term, or age 1
- sev
Infant severity level. 1-5
- used
Whether or not the category is used in the RA model
- plat, gold, silver, bronze, cat
Maturity/severity risk score for each metal level
Source
Data import and cleaning at: https://github.com/EeethB/edgedata/tree/main/data-raw
See Also
Other factors:
adult_demo
,
adult_enroll_dur
,
adult_group
,
adult_hcc
,
adult_interaction
,
adult_rxc_hcc_inter
,
adult_rxc
,
child_demo
,
child_group
,
child_hcc
,
infant_demo
NDC to Rx Condition Crosswalk - Table 10a
Description
A dataset containing the NDC to Rx condition mappings.
Usage
ndc_rxc
Format
An object of class tbl_df
(inherits from tbl
, data.frame
) with
12323 rows and 3 columns
- rxc
Rx condition number without leading zeroes
- desc
Rx condition description
- ndc
NDC that maps to
rxc
Details
The NDC system is a unique drug identifier system. But since there are so many drugs, and they very specific, the HHS-HCC model groups similar drugs into broader Rx condition categories.
Source
Data import and cleaning at: https://github.com/EeethB/edgedata/tree/main/data-raw
See Also
Other crosswalks:
hcpcs_rxc
,
icd_cc
Other RXC tables:
adult_rxc_hcc_inter
,
adult_rxc
,
hcpcs_rxc
,
rxc_hier
Rx Condition Hierarchies - Table 11
Description
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...).
Usage
rxc_hier
Format
An object of class tbl_df
(inherits from tbl
, data.frame
) with
1 rows and 3 columns
- rxc
Rx condition code without leading zeroes
- desc
Rx condition code description
- set_0
Rx condition code that falls below
rxc
on the hierarchy No leading zeroes
Source
Data import and cleaning at: https://github.com/EeethB/edgedata/tree/main/data-raw
See Also
Other RXC tables:
adult_rxc_hcc_inter
,
adult_rxc
,
hcpcs_rxc
,
ndc_rxc