Risk Adjustment in the Medicare Advantage Population Using Encounter Data

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Examines the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Category (HCC) risk model by comparing 2016-2022 Traditional Medicare (TM) claims and Medicare Advantage (MA) encounter data. Analyzes differences in the TM-based model and MA-based model and discusses risk-adjusted MA payment, MA payment policy, and enrollment incentives for various populations, including rural.

Caroline S. Carlin, Roger Feldman, Jeah Jung

Health Services Research, 61(5), e70165

10/2026

Benefit enrollment and application · Medicare · Medicare Advantage · Policy · Reimbursement and payment models · Statistics and data