This study examines the relationship between hospital structural characteristics and coding accuracy from the perspective of quality measurement. To measure coding accuracy for quality measurement, the study utilizes the "present on admission" indicator, a data element in the New York state hospital administrative database. This data element is used by hospitals across New York state to indicat...

This final rule implements standards for States related to reinsurance and risk adjustment, and for health insurance issuers related to reinsurance, risk corridors, and risk adjustment consistent with title I of the Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. These program...

Within the Internal Ratings-Based (IRB) approach of Basel II it is assumed that idiosyncratic risk has been fully diversified away. The impact of undiversified idiosyncratic risk on portfolio Value-at-Risk can be quantified via a granularity adjustment (GA). We provide an analytic formula for the GA in an extended singlefactor CreditRisk setting incorporating double default effects. It accounts...

Synopsis: Risk selection, which occurs when an individual’s demand for a product is correlated with her risk, creates inefficiencies and inequalities in markets for those products and services. Studies have shown that risk selection often occurs in health care markets, especially in markets for health insurance. Risk adjustment is a method that has been developed to correct those inefficiencies...

Conventional risk adjustment, which sets capitation payments equal to the average cost of individuals with similar observable characteristics, is not optimal if health plans can use private information to select low-cost enrollees. "Cost-minimizing risk adjustment" minimizes the sum of capitated HMO premiums plus FFS costs by balancing the gains from HMO cost efficiency against the overpayments...

Widespread integration of market-based incentives into healthcare systems calls for — and has elicited — increasing adoption of risk adjustment. By deterring selection, risk adjustment helps to assure fair and efficient payments among health insurers or capitated provider groups. However, since conventional risk adjustment allocates funds among regions or insurers according to current populatio...

BACKGROUND Incorporating longitudinal information into risk-adjustment models has been considered important. This study aimed to evaluate how morbidity trajectories impact risk-adjustment models in identifying high-cost cases. METHODS Claims-based risk adjusters, with or without morbidity trajectories derived from 3-year claims from Taiwan's National Insurance System, were used to predict bei...