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Medicare Advantage

A type of Medicare health plan offered by private companies that contract with Medicare to provide all of your Part A and Part B benefits. These plans typically include prescription drug coverage and may offer extra benefits.

Risk Adjustment

A method used by Medicare to pay health plans more for sicker patients and less for healthier ones, based on the health conditions (diagnoses) of their members. This is meant to ensure plans are compensated fairly for the costs of care.

Diagnostic Data

Information about a patient's medical conditions or illnesses, typically gathered from medical records and used to describe their health status.

Chart Review

A process where medical records are reviewed to identify or confirm patient diagnoses, often performed retrospectively without a new patient visit.

Health Risk Assessment

A questionnaire or survey used to gather information about an individual's health status, lifestyle, and potential health risks. It may identify existing conditions but is not typically a substitute for a clinical diagnosis.

Coding Patterns

The way medical diagnoses and procedures are recorded by healthcare providers using standardized codes. Differences in these patterns can affect how patient health is represented and, consequently, how much health plans are paid.