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Sunday, December 30, 2012

What Is Risk Adjustment?

By Darren Housely


A number of professionals believe that risk adjustment is something that can help to improve the fund distribution as well as help the amount of cost savings increase for the providers of the care as well as the insurance companies. There are many different issues that we face with our current healthcare system, and it is the thought of many that risk adjustment could play a big role in finding ways to improve this system and make it more effective. The types of solutions that are currently available for risk adjustment are being looked into and focused on as a way to improve them within the current health care field.

Risk adjustment is often used in the health care field as a way to calculate the amount of money a patient is likely to cost in relation to their health issues and care as well as other factors. It is through the evaluation and analysis of this information that allows health insurance companies as well as the centers for Medicare and Medicaid to calculate the possible costs for the care of an individual over one year. There are still a number of areas that can be improved within risk adjustment, and over the past years, there have been a number of improvements already made.

Another area that needs to be focused on in order to improve the capabilities of risk adjustment is the recording of patient information such as interactions and services rendered by health care providers. It is necessary to have the most detailed information about the patients as a way to accurately calculate and use risk adjustment. Without this information it is impossible to calculate correctly not matter how advanced the technology and software may become. It is the responsibility of both the health care provider, and the risk adjustment program to ensure the accuracy of calculations.

Focusing on the individual, and their specific issues, potential risks and other factors that add into the estimated yearly costs is one of the most important factors of risk adjustment. One of the areas that is being focused on within risk adjustment is the creation of a software that will be capable of completing accurate calculations of the overall financial risk of a particular individual or patient based on the factors presented. Currently there are many different health care companies that provide risk adjustment software, however there are still a number of improvements that can be made to this type of analytics.

To learn more about Risk adjustment go to Altegra Health.




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