Managed Healthcare Executive September 29, 2023
Jeremy Berk

Jeremy Berk, senior vice president of Risk Adjustment Solutions for PopHealthCare and Emcara Health, shares how plans must conduct a detailed analysis of how changes to risk adjustment models impact your plan in order to set an effective go-forward strategy.

Earlier this year, the Centers for Medicare & Medicaid Services (CMS) issued a final rule fundamentally changing the way Medicare Advantage (MA) plans are reimbursed. In addition, CMS separately clarified the RADV audit program, which now increases the enforceability of penalties for plans who are not in compliance. The goals of these rulings include transitioning to ICD-10 condition categories, updating the model with more recent data and combatting coding variation while reducing opportunities to game the system.

The changes have...

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Topics: CMS, Govt Agencies, Insurance, Medicare Advantage
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