Part 1 below covers key tradeoffs and the first two of four categories of strategies that have been advanced to improve risk adjustment in Medicare Advantage. Part 2 tomorrow will cover the remaining ...

Medicare Advantage is the dominant Medicare delivery system, now covering 54% of all Medicare enrollees. With the increase in enrollment and federal spending, however, has come increased scrutiny from ...

In this proposed rule, HHS notes that risk adjustment transfers currently occur 8 to 10 months after the end of a benefit year and that, because of the “time value of money,” this payment lag benefits ...

Capturing accurate diagnostic codes through comprehensive risk adjustment programs has become increasingly important for provider-sponsored health plans to improve patient care and clinical quality.

Major insurers are gaming Medicare Advantage’s risk adjustment system to reap higher payments from the government, costing Medicare billions of dollars, according to a new analysis of CMS data.