Claims data, which form the foundation of risk adjustment in payment for health care services, may reflect efforts to capture more—or more severe—clinical conditions rather than true changes in health ...

Medicare Advantage plans and providers need to be aware of the recent increase in government enforcement of risk adjustment coding issues. In the past few years, the Office of the Inspector General ...

Part 1 yesterday covered key tradeoffs and the first two of four categories of strategies that have been advanced to improve risk adjustment in MA. Part 2 below covers the remaining two types of ...