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Managing Medicaid risk adjustment is almost never a top priority. State by state regulations differ, making it complicated and costly to perform, and it is not often financially worth the trouble. Medicaid risk adjustment is effectively budget neutral, in that the funding is a fixed pool, apportioning dollars between organizations covering those lives based on […]
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Completeness and Accuracy in Risk Adjustment
In mid-December, the Health and Human Services Office of the Inspector General (HHS-OIG) announced that an investigation into Medicare Advantage organizations (MAO) had found $6.7 billion in potentially unsupported risk adjustment payments, generated from chart review programs that overwhelmingly yielded additional diagnoses. The study further found that 99% of chart reviews resulted in added diagnoses—not […]
