Medicare Risk Adjustment

Posted on November 30, 2012 @ 2:17 pm

The risk adjustment model used by the Centers for Medicare and Medicaid services utilizes information that is gained through claims data as well as the patient’s health plan to develop the cost estimates for that The ability to estimate correctly what the cost of care is going to be for an individual member is a vital aspect in making an accurate Medicare risk adjustment model.

Many people all across the United States are currently utilizing the Medicare Advantage plans that are offered through the Centers for Medicare and Medcaid services. The Centers for Medicare and Medicaid services have worked to develop the Medicare risk adjustment model as a way of calculating and determining the amount and number of payments to be provided to the plan’s members or beneficiaries.

The amount of money that a patient, or plan member, is likely to incur over one year is what represents their “risk factor”. The method of risk adjustment is used throughout the health care industry and insurance companies and is always being further developed and changed. This model is used as a way to determine what the financial risk factor of each individual member is going to be through examining different aspects such as diagnostic data, age, current health status and patient history.

Health insurance companies plan a vital role in keeping the cost of the programs run by the Centers of Medicare and Medicaid services accurate. member. What this means is that an important role is played by the health insurance companies and their reporting of their clients health care. There is so much information that is gained through claims reporting and is used as a way to base the risk adjustment numbers of Medicare that it is vital that reporting is done accurately by the health insurance and health care providers. Correct and detailed reporting is something that can help to create more accurate estimates and can help to lessen the number of errors.

Many of the errors that occur commonly within this model are because of the reporting that occurs throughout patient interactions and doctor visits. Many different benefits will be able to be realized through the use of high quality and accurate claims reporting and risk adjustment. Also the amount of communication that happens between health care providers, the Centers for Medicare and Medicaid as well as insurance companies is an important part as well.

To learn more about Medicare Risk Adjustment go to Altegra Health.







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