Medicare Advantage risk adjustment is a payment system that adjusts the amount CMS pays plans based on the health status of their enrollees. Plans with sicker enrollees receive higher payments. Risk adjustment is designed to prevent plans from avoiding sicker patients.
Key Points
- Risk adjustment: adjusts payments based on enrollee health status
- Plans with sicker enrollees: receive higher payments
- Designed to prevent plans from avoiding sicker patients
- Based on diagnosis codes submitted by providers
- An independent agent can help you understand how risk adjustment affects plan benefits