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teleo-codex/inbox/archive/2026-01-00-commonwealth-fund-risk-adjustment-ma-explainer.md
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draft extraction 2 commonwealth-fund

Commonwealth Fund Risk Adjustment MA Explainer

Claim 1: CMS RADV audit validation

The CMS Risk Adjustment Data Validation (RADV) audits are designed to ensure the accuracy of payments to Medicare Advantage (MA) plans. These audits have been subject to industry disputes regarding their methodology.

Challenges

  • Industry groups argue that the RADV methodology does not accurately reflect the risk profiles of MA enrollees.

Claim 2: Regulatory response to baseline problem

The baseline problem in risk adjustment refers to the difficulty in establishing a fair benchmark for payments. Regulatory responses have aimed to address these discrepancies through various policy adjustments.