Certified Risk Adjustment Coder (CRC)

Which statement is TRUE regarding the Coding Intensity Adjustment?

1. MA plan risk scores and FFS scores typically decrease.

2. FFS scores and MA plan risk scores increase at the same rate.

3. FFS scores increase faster than MA plan risk scores.

4. MA plan risk scores increase faster than FFS scores.

The correct answer is: FFS scores and MA plan risk scores increase at the same rate.

The statement that MA plan risk scores and FFS scores increase at the same rate reflects a key aspect of how coding intensity adjustment works within Medicare Advantage (MA) plans and Fee-for-Service (FFS) Medicare. The coding intensity adjustment aims to ensure that risk scores for beneficiaries are accurately reflected and that coding practices in the MA sector do not lead to artificially inflated risk scores. In this context, it is recognized that both MA and FFS risk scores are influenced by similar factors, such as the health status of the covered populations and the methodologies used to calculate the risk scores. The goal is to maintain a balance so that the risk adjustment mechanisms remain consistent and equitable across both systems. By indicating that these scores increase at the same rate, the statement underscores the alignment between the two systems, reinforcing the principle that changes in coding practices and risk scoring impact both groups equivalently. This alignment is important for ensuring that both MA plans and FFS providers are accountable for accurately reflecting the health status of their beneficiaries, allowing for fair reimbursement practices. Therefore, understanding this balance is crucial for those working in risk adjustment coding, as it influences how healthcare services are funded and managed.