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Risk Adjustment is a process used by the Centers for Medicare and Medicaid Services (CMS) in the Medicare Advantage and Marketplace programs and by state Medicaid agencies to account for expected
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Risk adjustment is a method used to ensure that health insurance plans are compensated fairly for covering beneficiaries who may have higher healthcare costs.
Health insurance companies are typically required to file risk adjustment.
Risk adjustment is typically filled out by providing information on the health status and demographics of beneficiaries covered by a health insurance plan.
The purpose of risk adjustment is to help equalize the playing field for health insurance plans, ensuring that those who cover sicker individuals are appropriately compensated.
Information such as the health status and demographics of beneficiaries, as well as any diagnoses or conditions that may impact healthcare costs, must be reported on risk adjustment.
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