Is there a way for insurance companies to handle increased risk and the cost of "sicker" patients without denying them coverage? "CMS Risk Adjustment We've learned about reimbursement methods such as APC and DRG, but CMS risk adjustment is a newer form of reimbursement method that evaluates and predicts the cost based on the patient diagnoses. The evaluation equates to a "score" given to the patient in which the score predicts how much their healthcare services will cost. Risk adjustment is how insurance plans participating in the program receive payment based off of their member's diagnoses. You may be wondering, could the insurance company deny covering someone with a higher score with the fear of an increased cost to the insurance company?"