While the cost of the healthcare industry continue to rise despite efforts to lower them there have been a number of factors with increased important placed upon them. One of the largest issues with the health care industry is the rising cost of the centers for Medicare and Medicaid services. Tightening the budget of the programs offered through CMS is one of the main areas being focused on.A large part of trying to rain in the costs of plans such as the Medicare advantage plan is that of risk adjustment. Risk adjustment is the process of determining the projected or anticipated costs of a plan member through the review of encounter data as well as other patient information such as claims data and medical history. Accurate risk adjustment and provide information necessary to increase cost savings and our unnecessary Medicare payments.
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.
Prospective risk adjustment services are considered to be a new advancement as far as risk adjustment services are concerned. However so far theses services have had a great success in yielding the types of results that Medicare Advantage health plans are looking to achieve. While retrospective risk adjustment focuses on establishing the correct amount of HCC categories, prospective risk adjustment focuses on outreach, training and education for patients, physicians and plan providers. This includes education about how to improve documentation by physicians about patient interactions which can lead to a smaller amount of errors within CMS.
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. Proper documentation of patient encounters and interactions will aide in creating a system that is more accurate and can increase cost savings which is a main goal.
To learn more about Prospective Risk Adjustment go to Altegra Health.
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.
Prospective risk adjustment services are considered to be a new advancement as far as risk adjustment services are concerned. However so far theses services have had a great success in yielding the types of results that Medicare Advantage health plans are looking to achieve. While retrospective risk adjustment focuses on establishing the correct amount of HCC categories, prospective risk adjustment focuses on outreach, training and education for patients, physicians and plan providers. This includes education about how to improve documentation by physicians about patient interactions which can lead to a smaller amount of errors within CMS.
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. Proper documentation of patient encounters and interactions will aide in creating a system that is more accurate and can increase cost savings which is a main goal.
To learn more about Prospective Risk Adjustment go to Altegra Health.
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