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Risk Adjustment of Medicare Capitation Payments Using
the CMS HCC Model
Gregory C. Pope, M.S., John Latter, Ph.D., Randall P. Ellis, Ph.D., Arlene S. Ash, Ph.D., John Z. Iranian, M.D., M.P.P., Lisa
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What is risk adjustment of medicare?
Risk adjustment of Medicare is a method used to calculate payments to health insurance plans participating in the Medicare program. It takes into account the health status and demographic characteristics of the plan's enrollees.
Who is required to file risk adjustment of medicare?
Health insurance plans participating in the Medicare program are required to file risk adjustment of Medicare.
How to fill out risk adjustment of medicare?
To fill out risk adjustment of Medicare, health insurance plans need to collect and report data on the health status and demographic characteristics of their enrollees. This data is used to calculate risk scores and adjust payments.
What is the purpose of risk adjustment of medicare?
The purpose of risk adjustment of Medicare is to ensure that health insurance plans are appropriately compensated for the health risks of their enrollees. It helps to create a level playing field and prevent plans from avoiding high-risk individuals.
What information must be reported on risk adjustment of medicare?
Health insurance plans must report data on the health conditions, demographics, and utilization of their enrollees to complete risk adjustment of Medicare. This includes information such as age, gender, diagnoses, and procedures.
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