Risk adjustment plays a very large role within the health care industry. Especially in connection to how the Centers for Medicare and Medicaid Services allocate funds for plan members. Risk adjustment is centered around the need to determine how much a health plan member is going to cost in terms of services and treatments needed and rendered. It is through risk adjustment that providers are compensated by CMS as well as how much the plan enrollee will have to pay. As the importance of risk adjustment continues to grow and be highlighted by the health care industry providers, the number of types of risk adjustment methods continues to grow.
Each individual member who is enrolled in a Medicare advantage plan has a risk adjustment performed each year to determine the anticipated cost of that individual over a years' time in terms of the cost of health care services and treatment provided. Correctly calculated risk adjustment numbers are essential to properly budgeting and minimizing unnecessary costs as well as providing plan members with the necessary and needed treatment services.
The centers for Medicare and Medicaid are currently working towards shrinking the payments to Medicare Advantage plans via risk adjustment by performing audits and assessing the claims and diagnostic codes applied to plan members. This makes it more important than ever that all patients have the correct codes applied to their member information, and that the services and treatments rendered are properly recorded and coded. This is where retrospective risk adjustment becomes an important part of the equation. Retrospective risk adjustment focuses on looking at each individual patients charts, encounter data, and claims data in order to verify that all of the diagnostic codes that apply to them are actually a part of their member profile.
In many cases, Medicare Advantage members may have a number of health issues that are not properly coded for, and in those cases, they would not receive compensation for those medical issues that were never coded for on their charts. There are a number of different health care companies that are working towards ensuring the proper coding for patients charts through the use of retrospective risk adjustment by reviewing past charts and patient information.
To learn more about Retrospective Risk Adjustment go to Altegra Health.
Each individual member who is enrolled in a Medicare advantage plan has a risk adjustment performed each year to determine the anticipated cost of that individual over a years' time in terms of the cost of health care services and treatment provided. Correctly calculated risk adjustment numbers are essential to properly budgeting and minimizing unnecessary costs as well as providing plan members with the necessary and needed treatment services.
The centers for Medicare and Medicaid are currently working towards shrinking the payments to Medicare Advantage plans via risk adjustment by performing audits and assessing the claims and diagnostic codes applied to plan members. This makes it more important than ever that all patients have the correct codes applied to their member information, and that the services and treatments rendered are properly recorded and coded. This is where retrospective risk adjustment becomes an important part of the equation. Retrospective risk adjustment focuses on looking at each individual patients charts, encounter data, and claims data in order to verify that all of the diagnostic codes that apply to them are actually a part of their member profile.
In many cases, Medicare Advantage members may have a number of health issues that are not properly coded for, and in those cases, they would not receive compensation for those medical issues that were never coded for on their charts. There are a number of different health care companies that are working towards ensuring the proper coding for patients charts through the use of retrospective risk adjustment by reviewing past charts and patient information.
To learn more about Retrospective Risk Adjustment go to Altegra Health.
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