3 Steps to Prepare for a Risk-Adjustment Audit

Risk adjustment plays a significant role in Medicare Advantage contracts, commercial capitated payment arrangements, and CMS alternative payment models such as shared-savings contracts and accountable care organizations.

As with any payment model, there’s always the potential to "game the system" and over-report CMS-HCCs to increase reimbursement. Thus, it’s not surprising that the agency has begun to perform Risk Adjustment Data Validation (RADV) audits of its Medicare Advantage plans. Find out how to prepare for a risk-adjustment audit.

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