Understanding Risk Adjustments & Hierarchical Condition Categories
In July 2023, the Office of Inspector General (OIG) added Medicare Part C High-Risk Diagnosis Codes (AKA Risk Adjustment) Tool Kit to their work plan, with the intention of creating a resource to assist Medicare Advantage (MA) organizations with analyzing the accuracy of their risk adjustment data, which, in turn, gets submitted to CMS for reimbursement purposes. What is Risk Adjustment (RA)? Risk adjustment is: Why is RA Important? Accurate documentation and coding of a…
