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Tag: medicare risk adjustment

Important Facts About Medicare Risk Adjustment

Important Facts About Medicare Risk Adjustment

Health
A statistical method for predicting a person's likely use and costs of health care services is known as risk adjustment. It is used in Medicare Advantage to adjust the capitated payments made by the federal government to cover enrollees' expected medical costs. This, in turn, helps to ensure that a plan's contracted providers have enough resources to care for beneficiaries and are not tempted to avoid sicker and more expensive patients. Overpayments Risk adjustment is a critical component of the Medicare program. The medicare risk adjustment information incentivizes plans to accept sicker members. These patients can be coded for more conditions, allowing the plans to manage care better and make more money. However, it is important to remember that risk adjustment can have a negative impac...