Download the slides HERE.
Risk adjustment is a statistical process that takes into account the underlying health status and health spending of a patient by looking at the patient’s demographic data and diagnoses submitted on their claim to calculate a patient risk score. The patient risk score directly impacts the allowed reimbursement from insurers or providers that are reimbursing for the cost of that patient care.
While there are many different models of risk adjustment, some of which account for pharmaceutical codes and supplemental data files, the diagnoses submitted on claims is the backbone to each model. Therefore, coding accuracy is essential for appropriate reimbursement.
Tune into this short video presented by Amber Detty, CHDA, where she discusses the basics of risk adjustment, the different models used, and shares an example which highlights the importance of risk adjustment for reimbursement.
Presented by: Amber Detty
Connect with Amber on LinkedIn or via email adetty@amerihealthcaritas.com.
Resources
- HHS_HCC: https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance#Premium-Stabilization-Programs
