Medicare Advantage organizations may be improperly using health risk assessments to increase risk-adjusted reimbursement, according to a report HHS’ Office of Inspector General issued in September.

From free wellness visits to prescription drug savings and dental coverage, Medicare offers far more benefits than many ...

Some limits on how the assessments are used for adding new diagnosis codes might be justified to ensure Medicare Advantage plans aren’t overpaid, researchers wrote. Under MA, insurers contract with ...

Medicare covers fall risk assessments during routine preventive visits for beneficiaries enrolled in Part B. If you have a history of recent falls or issues with walking and balance, you may be a ...

During a Medicare annual wellness visit, a healthcare professional may include a Social Determinants of Health Risk Assessment. This helps healthcare professionals determine whether there are ...

Under the current Medicare Advantage (MA) risk-adjustment system, plans are incentivized to report diagnosis codes on enrollees’ medical claims reflecting additional and more severe health conditions ...

Some research suggests that risk adjustment plays a substantial role in explaining the high levels of government spending on Medicare Advantage (MA). We studied whether the reliance on diagnosis codes ...

Physician groups under 2-sided risk–based Medicare Advantage provide care associated with higher quality and efficiency compared with care by these same groups under fee-for-service Medicare.

Food insecurity identification modeling for Medicare can establish a reliable method of prioritizing members at risk of food ...

UnitedHealth Group stood out from its peers in a new federal watchdog report that questions how Medicare Advantage insurers have used diagnosis data to boost payments from the government program for ...