Risk Adjustment & Attribution
Expert articles and analysis related to risk adjustment & attribution.
AI Summary — Last 7 Days
Medicare Advantage risk adjustment remains under intensified scrutiny as MedPAC defended its $76B overpayment estimate while insurers pressed Congress to revise the methodology, and CMS Administrator Dr. Mehmet Oz signaled continued Trump administration interest in tighter MA oversight despite softening some proposed reforms—raising the stakes for plans, delegated risk groups, and providers dependent on coding-driven revenue. At the same time, enforcement pressure is reinforcing the operational risk around diagnosis capture, with a major MA False Claims Act settlement and renewed coding questions around HCCs on preventive visits underscoring the need for auditable documentation, attribution discipline, and compliant risk adjustment workflows. Medicaid managed care is also facing rate-setting disruption from the 2025 reconciliation law and new state-directed payment limits, creating potential plan-exit and network-stability risks that VBC organizations should factor into attribution, contracting, and population health investment decisions (MA overpayment fight; Medicaid managed care uncertainty).
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