With the efforts to decrease the cost of health care there is a large amount of importance of being placed upon risk adjustment and risk adjustment methods. It is believed that high-quality improperly calculated risk adjustment can play major role in decreasing the cost within our health care industry. Risk adjustment is what is used by health insurance plans as well as the centers for Medicaid and Medicare as a way to determine anticipated costs.
One of the reasons for the increased amount of focus on risk adjustment methods as well as outcomes is the need to lower the costs of the health care industry. Risk adjustment is used to determine the amount each patient or member, and their health care provider, will receive from the Medicare Advantage plans. Risk adjustment focuses on the coding of a patients chart, and analyzing the codes applied and determining a monetary value from these codes. However, if the codes are not correct, or there are a number of diagnostic codes missing for an individual then the calculation will likely be far too low, causing excessive costs.
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.
Recently, the centers for Medicare and Medicaid services established a number of new condition categories within their current H CC coding model which in turn makes risk adjustment an even more important factor to consider. In this case retrospective risk adjustment is necessary to ensure each plan member is receiving all of the benefits that they are entitled to. With the expansion of condition categories I need to review and look over patient's chart and counter data and claims with these new categories in mind. Retrospective risk adjustment includes a detailed review of past interactions charts and claims data on a patient to ensure that they are being properly coded for all of the necessary health issues they have.
To learn more about Retrospective Risk Adjustment go to Altegra Health.
One of the reasons for the increased amount of focus on risk adjustment methods as well as outcomes is the need to lower the costs of the health care industry. Risk adjustment is used to determine the amount each patient or member, and their health care provider, will receive from the Medicare Advantage plans. Risk adjustment focuses on the coding of a patients chart, and analyzing the codes applied and determining a monetary value from these codes. However, if the codes are not correct, or there are a number of diagnostic codes missing for an individual then the calculation will likely be far too low, causing excessive costs.
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.
Recently, the centers for Medicare and Medicaid services established a number of new condition categories within their current H CC coding model which in turn makes risk adjustment an even more important factor to consider. In this case retrospective risk adjustment is necessary to ensure each plan member is receiving all of the benefits that they are entitled to. With the expansion of condition categories I need to review and look over patient's chart and counter data and claims with these new categories in mind. Retrospective risk adjustment includes a detailed review of past interactions charts and claims data on a patient to ensure that they are being properly coded for all of the necessary health issues they have.
To learn more about Retrospective Risk Adjustment go to Altegra Health.
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