What do the Monthly Membership Report (MMR) and Model Output Report (MOR) pertain to?

The Monthly Membership Report (MMR) and Model Output Report (MOR) are crucial components in assessing the financial and operational performance of Medicare Advantage plans. These reports play a significant role in determining the payments made to Medicare plans based on the risk adjustment scores assigned to their enrolled members.

The MMR provides details on the membership of a plan, including counts of enrolled members, demographic information, and changes in membership status. This information is essential for health plans to evaluate their enrollments and project future revenue.

The MOR, on the other hand, elaborates on risk scores and the projected payments to those plans based on the demographic and diagnostic information submitted to CMS. It outlines how adjustments are made to payments based on the health statuses of the members enrolled in the plans.

By providing these critical insights, the MMR and MOR directly relate to the financial aspects of Medicare plans, specifically guiding them in understanding and anticipating their payment structures as related to the level of risk associated with their member populations.