Pre-Submission Risk Adjustment Audits: Preventing Medicare Advantage Plans from Draining Medicare Funds Dry

Author:Casie C. Rodenberger
Position:J.D. Candidate, The University of Iowa College of Law, 2018; M.S.W., Washington University in St. Louis, 2012; B.A., The University of Portland, 2011

The Centers for Medicare and Medicaid Services ("CMS") pays private organizations on a capitated payment rate to provide medical services to Medicare beneficiaries in the Medicare Advantage Program. To decrease the risk of the capitated payment model, CMS uses risk adjustment to increase payment for beneficiaries with a higher risk score. The risk adjustment data submission process is at great... (see full summary)

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