Certified Risk Adjustment Coder (CRC)

What is the purpose of the coding intensity adjustment?

1. To determine how many patients are enrolled in Medicare Advantage

2. To adjust for differences in coding patterns between plans

3. To review inpatient claims covered by Part A

4. To regulate outpatient claims for Medicaid

The correct answer is: To adjust for differences in coding patterns between plans

The purpose of the coding intensity adjustment is to address the variations in coding practices between different Medicare Advantage plans. This adjustment is essential because it aims to create a level playing field by ensuring that reimbursement rates reflect the actual risk levels of enrolled patients. In other words, since some plans may code certain diagnoses more thoroughly or accurately than others, the coding intensity adjustment helps to normalize these discrepancies. By adjusting for these differences, Medicare can ensure that the risk scores calculated for plans more accurately represent the overall health status of their enrollees, preventing any single plan from having an unfair advantage solely due to more aggressive coding practices. This adjustment ultimately improves the integrity and fairness of reimbursement in the Medicare Advantage program, promoting equitable access to healthcare for all beneficiaries.