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Risk Adjustment

Risk Adjustment (RA) requires a NEW way of thinking! RA is a statistical predictive methodology that takes into account the underlying total health status of a patient to predict future health spending based predominantly on their burden of specific chronic disease(s) that qualify as a Risk Adjustment Factor (RAF), and to a lesser extent on their socio-demographics. There are approximately 8,830 qualifying RAF conditions, out of more than 71,468 ICD-10 diagnosis codes.

RA sets out to create a “level playing and paying field” among the physicians for fairer comparisons of clinical and financial outcomes by accounting for expected differences in utilization of healthcare service and spending across patients.
Education is KEY!

RAF’n the Rapids of RISK-ADJUSTED REIMBURSEMENT

The level of physician awareness, knowledge and engagement with the Recognition, Documentation and Coding of HCC-RAF Risk Adjustment is vitally important for Value-Based, Pay-for-Performance reimbursement. It can make or break your bottom line!

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Risk Adjustment for Primary Care

The Annual Wellness Visit (AWV) and the Annual Preventative Exam (APE) are opportune times for capturing conditions that impact a patient’s RAF.  It’s extremely important that Primary Care Providers understand and robustly embrace RA.

Managed Care Risk Adjustment

Providers must understand the importance of RA in managed care contracts. RA helps payers predict the cost of care for their patient population, and RA increases a provider’s reimbursement when it is accurately completed.

Risk Adjustment Documentation

Every risk adjusted ICD-10 HCC code must have documentation to support it in the patient’s record. M.E.A.T. documentation principles are the most recognized in the industry. Let us simplify the burden of documentation for your providers!

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