Health plans operating in healthcare’s changing landscape encounter many unknowns. With the passage of the Affordable Care Act, health plans who can collect the most accurate data on their member populations will improve their opportunities for financial, quality, and clinical improvements. Accurate coding and efficient medical record retrieval services are an effective way to manage the care, medical costs, and financial impact of risk-adjustable members.
By RaeAnn Grossman What does your risk adjustment team need to think about from application time to bid season? Answers include but are not limited to: Are we changing our formulary and will this impact Rx risk adjustment? Are we narrowing our provider networks and will this impact campaigns or waves? Are we capitating more […]
By RaeAnn Grossman First, have you integrated compliance and risk adjustment? Have you embedded your risk mitigation strategies? Here are a few items that should be on your compliance for risk adjustment checklist: Review coding guidelines quarterly (internally and with vendors) Perform 2LR and 3LR annually Embed claims validation into Medicare Advantage, Commercial, and Medicaid […]