Which statement is NOT included in the ten guiding principles of Medicare's current risk adjustment approach?

The correct answer identifies a statement that does not align with the ten guiding principles of Medicare's current risk adjustment approach. The principle that discretionary diagnostic codes should be permitted is inconsistent with the philosophy behind the accuracy and reliability of risk adjustment.

The Medicare risk adjustment model aims to ensure that measures are robust and applicable across diverse patient populations, with an emphasis on comprehensive and verifiable data to reflect a patient’s health status accurately. Therefore, allowing discretionary codes could introduce variability and subjectivity in the reporting process, potentially undermining the reliability of risk adjustment calculations.

In contrast, the other principles focus on strengthening the foundations of risk adjustment through the use of substantial sample sizes, ensuring the measures reflect valid clinical realities, and protecting providers from negative consequences of comprehensive reporting. These principles are fundamental to maintaining the integrity and fairness of the risk adjustment framework, emphasizing stability, validity, and accurate representation of patient conditions.