Risk Adjustment & Integrity
Expert articles and analysis related to risk adjustment & integrity.
AI Summary ā Last 7 Days
Risk adjustment and integrity risk is intensifying across Medicare Advantage and VBC: CMSā latest recalculation of MA Star Ratings adds another layer of payment volatility to a bonus system worth roughly $16 billion, while OIGās new MA industry-specific guidance and renewed focus on RADV extrapolation underscore that coding, documentation, and audit exposure remain central financial risks for plans and delegated-risk providers. At the same time, ACO and specialty-model participants are moving toward more sophisticated actuarial toolingāe.g., Arbital Healthās ATLAS for modeling CMS LEAD ACO exposureābecause benchmark design, attribution, and risk-score mechanics are increasingly determining whether value-based contracts create upside or unpriced downside. See: Wakely RADV extrapolation guide and [Arbital ATLAS for CMS LEAD](https://news.google.com/rss/articles/CBMixwFBVV95cUxNTVg3ekJxUXl5VndEbjhXVmR6WUo4UGoyWHROTTVmUmF4LXdOOTBjNno4Sll3MjhVYm1CSm9wbVhGUWxJWEphUDF0emlnbGdrUmcwWXFzOVZhRnFETE0wY2VKbk1JNE5XaU5oT1
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