Is Medical Risk Adjustment Worth the Effort?

Medical Risk Adjustment

Risk adjustment is a key factor in the healthcare sector. It is a mechanism that aims at predicting the cost incurred to facilitate payments for Part D plans, Medicare Advantage plans plus health plans. Initially, medical risk adjustment was limited to Medicare and Medicaid risk adjustment. But things have changed. Today, it is used as a way of ensuring that health insurance plans are well funded to avoid future financial challenges. Funds inadequacy interferes with the ability of an insurance company to care for bills of high-risk patients.

The insurance companies are usually compared based on quality plus the services offered. Such factors form the basis for value-based buying. To get the most from a medical risk adjustment program, you must integrate the right resources and technology. Also, this calls for help from risk adjustment experts. The process requires a detailed evaluation plus a good analysis of your initiative and data.

The most accurate way of getting everything right is by employing an outside look. Involving the experts such as GeBBS Healthcare Solutions, Inc. will guarantee you accurate RAF score. Besides, they will use their skills to capitalize on the impact. Basically, the team will provide you with an accurate and actual state of your organization`s risk score after conducting a wide-ranging review of your data. Therefore, involving them entitles you to timeless, top quality, and correct documentation. You can rest assured of optimum results.

What is the Importance of Medical Risk Adjustment?

Risk adjustment is crucial in that it helps health insurance plans get reasonable payments. It achieves this by evaluating them based on efficiency as well as the quality of services they provide. Besides, this mechanism encourages insurance companies to offer quality care. Here are other reasons why you should consider seeking help with your medical risk adjustment:

  • Its an excellent approach for quality recording and evaluating measures
  • The method creates a platform where the payers and the providers are compared to their opponents to determine the quality of service and efficiency of the operation
  • Uniting evidence-based approaches and risk scores with risk adjustment is excellent since it helps the care teams and providers come up with effective post-discharge plans featured with efficient follow-ups
  • Outside the projected analytics, risk adjustment approaches can be of much help in evaluating a patient’s risk from all dimensions

How the Experts Apply Risk Adjustment in Healthcare

Medical risk adjustment approaches are meant to account for patient`s variations in details and case mixes over time. Risk management has helped remove ineffective plans from the health plans. There are 3 categories for risk dimensions in care. They include:

  • Health status
  • Patient health-based behavior
  • The social determinants

When offering incentives to lure high-cost individuals, you must ensure that there are adequate resources to provide quality healthcare services to clients without overcompensation. The approach employed in risk adjustment premium differs based on such things as:

  • Patient population
  • Payment source
  • Healthcare market directive.

Finally, contact the experts GeBBS Healthcare Solutions, Inc., to help you with medical risk adjustment. They will collect vital medical records and ensure that each of them is correctly coded. That way, you will get accurate results. Thanks to their excellent proprietary technology, iCode Risk Adjustment, and their effective provider-conscious processes, the providers get satisfying results.