The issues within our health care industry in terms of rising costs have become a topic of deliberation. This is especially true when talking about the rising costs of the Centers of Medicare and Medicaid Services. Trying to decrease the costs of the programs within these centers has had a large importance placed upon it. One of the factors being looked into is that of risk adjustment and how it can help to decrease the spending on programs such as Medicare Advantage plans. It is believed that certain risk adjustment methods and models can be used as a way to vastly decrease the excessive spending of Medicare on the Medicare Advantage plans.
Risk adjustment can be described as the way that the projected costs of an individual or group of individuals is likely to incur over the span of a year. This cost is the amount that CMS will provide the member's private health care plan with in order to cover the cost of services and treatments rendered. Risk adjustment works by looking at the patient's medical records, history, current health status, medications as well as what services were rendered and when. Each patient is assigned a certain number of diagnostic codes which refer to a health or medical issue. Each of these codes is also assigned a likely monetary value. The number of codes a patient is assigned reflects the amount of money that the patient's health care plan will be compensated for.
Properly reporting and coding for patients is a vital part of creating a system for the Centers of Medicare and Medicaid that will work and not waste money. Unfortunately, there are a number of issues with the current coding system, and in many cases individuals are not assigned with the proper amount, or type of diagnostic code that applies to them. This is where the creation and use of prospective risk adjustment has become so important. While retrospective risk adjustment looks at past charts and the accuracy of coding, prospective risk adjustment looks forward to correcting errors before they happen.
The focus of prospective risk adjustment is the education and outreach that is needed for both patients undergoing treatments as well as physicians recording and reporting these issues. An increased amount of productivity and knowledge of proper reporting will decrease errors which will also decrease costs.
As the Centers for Medicare and Medicaid Services begin to focus more heavily on tightening the budget and auditing plan members through RADV audits, prospective risk adjustment becomes even more important. It allows for better audit preparation, as well as properly submitting data the first time, which can lead to lower costs within administration. Prospective risk adjustment is mainly focused on preventing errors which in turn can lead directly to lower costs. Being able to get these coding issues correct the first time around is a key to minimizing the cost of time consuming errors.
Risk adjustment can be described as the way that the projected costs of an individual or group of individuals is likely to incur over the span of a year. This cost is the amount that CMS will provide the member's private health care plan with in order to cover the cost of services and treatments rendered. Risk adjustment works by looking at the patient's medical records, history, current health status, medications as well as what services were rendered and when. Each patient is assigned a certain number of diagnostic codes which refer to a health or medical issue. Each of these codes is also assigned a likely monetary value. The number of codes a patient is assigned reflects the amount of money that the patient's health care plan will be compensated for.
Properly reporting and coding for patients is a vital part of creating a system for the Centers of Medicare and Medicaid that will work and not waste money. Unfortunately, there are a number of issues with the current coding system, and in many cases individuals are not assigned with the proper amount, or type of diagnostic code that applies to them. This is where the creation and use of prospective risk adjustment has become so important. While retrospective risk adjustment looks at past charts and the accuracy of coding, prospective risk adjustment looks forward to correcting errors before they happen.
The focus of prospective risk adjustment is the education and outreach that is needed for both patients undergoing treatments as well as physicians recording and reporting these issues. An increased amount of productivity and knowledge of proper reporting will decrease errors which will also decrease costs.
As the Centers for Medicare and Medicaid Services begin to focus more heavily on tightening the budget and auditing plan members through RADV audits, prospective risk adjustment becomes even more important. It allows for better audit preparation, as well as properly submitting data the first time, which can lead to lower costs within administration. Prospective risk adjustment is mainly focused on preventing errors which in turn can lead directly to lower costs. Being able to get these coding issues correct the first time around is a key to minimizing the cost of time consuming errors.
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