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Medicare Risk Adjustment


A handbook on Medicare Risk Adjustment

If someone says, get a less expensive insurance plan by figuring out your fitness level and that you only have the occasional doctor visit, ignore them. The Affordable Care Act (ACA) implies that the companies that offer health insurance shouldn’t convict the healthy individuals for having a less expensive insurance plans.

ProMed’s Medicare Risk Adjustment solution features the patient risk score which will be the approximation of cost that the patient has to bear. Risk Adjustment Factor (RAF) scheme would help the unhealthy patient who has below average RAF score from impacting the revenue of those with an above average RAF score. With the implementation of the Affordable Care Act, it is mandatory to offer complete health coverage to everyone without considering their condition. Hierarchical condition categories and the Medicare Risk Adjustment models are not new to this industry but have been emphasized as the Medicare Advantage Plans commenced to claim RAF scores for reimbursement. It has become increasingly important to any coding leader and commercial payer. It is essential to have an understanding of HCC to go with any Medicare Risk Adjustment solution.

Risk Adjustment Solutions

ProMed Risk Adjustment Solution uses a RA model where a patient demographics and diagnosis are gathered and filed to utilize to bring up a risk score. By this data, bills could easily be measured for a patient. ProMed risk adjustment coders are successful because they take into consideration patient evaluation, care, and treatment including co-existing conditions, chronic conditions, and treatments rendered.

How Promed Medicare Risk Adjustment Solution distinguish them?

Our certified coders help clinics, hospitals and physician groups in the accurate reimbursements from Medicare Advantage plans. The expertise of our coders comes into play post the review of clinical documentation with the outcome being the precise diagnostic and CPT codes. This helps in the reduction of medical request denials for our customers, increases clean claim ratio, enhances the accuracy of the patient’s score and provides faster reimbursement.