Certified Risk Adjustment Coder (CRC)

What is the focus of CMS's adjustment related to risk scores?

1. To compare outcomes of Medicare Advantage and Medicaid

2. To analyze coding differences in Part A versus Part B

3. To maintain risk scores at consistent levels across plans

4. To reduce overall healthcare costs

The correct answer is: To maintain risk scores at consistent levels across plans

The focus of the Centers for Medicare & Medicaid Services (CMS) regarding risk scores is to maintain consistency across plans. This approach helps ensure that the risk scores accurately reflect the health status of beneficiaries and allow for fair comparisons and adjustments in payments to Medicare Advantage plans. By keeping risk scores at consistent levels, CMS can mitigate disparities that may arise from variations in coding practices or plan management strategies, thus promoting equitable funding for the care of enrollees in different Medicare Advantage plans. This consistency is crucial because it directly impacts how much funding is allocated to plans based on the perceived health risk of their members. If one plan consistently reported higher risk scores than another without a true reflection of the population's health, it could lead to unfair advantages in funding and, ultimately, patient care. Therefore, ensuring that risk scores are maintained at consistent levels across plans supports effective management of healthcare resources. In contrast, options that focus on comparing outcomes between Medicare Advantage and Medicaid, analyzing differences in services like Part A and Part B, or reducing overall healthcare costs represent different goals that, while relevant to healthcare management, do not directly capture the fundamental objective of maintaining consistent risk scores across plans.