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Medicare Risk Adjustment


Risk adjustment is a process that the Centers for Medicare & Medicaid Services (CMS) uses to reimburse Medicare Advantage (MA) plans based on the health status of members. Risk adjustment ensures that CMS pays plans appropriately for members’ predicted health costs based on demographics (age and gender) and health status (claims data).



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First Published:08/09/2017
Latest Revision:06/13/2018
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