BC Advantage - 2019 Issue 6

Extrapolation Policies Apply to RADV Audits

Risk Adjustment is a program that was implemented to identify and support Medicare beneficiaries with health conditions, illnesses, or injuries that put them at risk of death or organ system/bodily function failure. Through Risk Adjustment (RA), Medicare ensures their beneficiaries are being followed at least annually for any healthcare conditions or issues they may have and chronic health risks are being evaluated, monitored, and treated properly. To summarize a complex process, commercial insurance companies offer Medicare Advantage (MA) plans to Original Medicare beneficiaries. They also offer additional benefits to these beneficiaries, not offered through Original Medicare, such as...

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