Certified Risk Adjustment Coder (CRC)

What is true about MA plan risk scores compared to FFS scores?

1. MA plan risk scores decrease faster than FFS scores

2. MA plan risk scores remain static

3. MA plan risk scores increase faster than FFS scores

4. MA plan risk scores are always lower than FFS scores

The correct answer is: MA plan risk scores increase faster than FFS scores

MA plan risk scores are designed to account for the health status and the specific care needs of members enrolled in Medicare Advantage (MA) plans. These scores reflect the complexity of patients' conditions and the associated costs of care. Compared to Fee-for-Service (FFS) scores, MA plan risk scores tend to be more dynamic due to the more integrated and comprehensive nature of care management in MA plans. As MA plans often serve populations with varying health conditions, the algorithms used to calculate these risk scores adapt more readily to changes in patient health status and the utilization of healthcare services. As a result, the risk scores can increase more rapidly when there are shifts in patient health conditions or when more complex care is warranted. This characteristic underscores the focus on proactive health management within MA plans, whereas FFS scores remain more stagnant because they are based on traditional service delivery without as much emphasis on overall patient health improvement. Overall, the faster increase in MA plan risk scores compared to FFS scores reflects the ongoing assessment of patient needs and management of healthcare resources within the MA framework.