BC Advantage - 2023 Issue 7

As CMS Focuses on Quality, There Are Monumental Changes to Reimbursement for Quality on the Horizon!

The Centers for Medicare and Medicaid Services (CMS) utilizes risk adjustment factors to estimate the cost of Medicare Advantage (MA) beneficiaries and those associated costs of providing care.  Risk adjustment factor scores govern the amount paid by the health plan during the year for the beneficiary's care.  The risk adjustment scores factor in demographic and specific life and health information, such as the beneficiary's:AgeBiological sexGeographical locationDual coverage eligibilityAcquired health statusActive medicationsThe presence and active nature of multiple chronic conditions whose level of severity are much greater, and the estimated cost to treat the beneficiary are estimated...

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