What is Medicare Risk Adjustment?
Medicare Risk Adjustment was introduced in 2000 to make sure that the managed care programs are paid accurately and on time. Prior to this, they were paid on the basis of demographic and geographic information only, which led to a lot of confusion
The Medicare risk adjustment program allows managed care organizations to increase their revenue as it focuses more on the documentation of patients with multiple chronic diseases. The program also emphasizes that health care institutions revise the list of members they provide services to and hire doctors who can treat patients with multiple diseases. Furthermore, it suggests that facilities that are most visited by patients with chronic illness, diabetes and heart disease need to extend their services accordingly.
How This Program Works
The program suggests redesigning many processes, such as patients with serious illness can be called on the same day rather than just once a week - irrespective of whether the appointment is available or not and a review of the discharge sheet. It also suggests that if a facility is visited by a large number of patients that have serious illnesses, the facility should focus on increasing the facilities for such patients.
How Are Payments Determined?
Medicare determines the compensation plan for a managed care organization by gathering its information and assigning individual codes to every disease they have treated. Medicare then uses the following four models to determine accurate reimbursement plan for it:
1. New enrollee model
2. Long-term care institution
3. End Stage Renal Disease
4. Community model
Documenting Information
In Medicare risk adjustments, for the sake of accuracy, the details are recorded in terms of medical charts. These documents can then be used for compliance purposes as well.
How to Report Data
Risk Adjustment Processing System (RAPS) is a program used to report data quarterly. The Centers for Medicare and Medicaid Services even offer training programs to ensure it is used effectively.
In addition this, the records of Medicare risk adjustment can be used by physicians to check which patients' documentations need to be completed before the year ends.
Medicare Risk Adjustment was introduced in 2000 to make sure that the managed care programs are paid accurately and on time. Prior to this, they were paid on the basis of demographic and geographic information only, which led to a lot of confusion
The Medicare risk adjustment program allows managed care organizations to increase their revenue as it focuses more on the documentation of patients with multiple chronic diseases. The program also emphasizes that health care institutions revise the list of members they provide services to and hire doctors who can treat patients with multiple diseases. Furthermore, it suggests that facilities that are most visited by patients with chronic illness, diabetes and heart disease need to extend their services accordingly.
How This Program Works
The program suggests redesigning many processes, such as patients with serious illness can be called on the same day rather than just once a week - irrespective of whether the appointment is available or not and a review of the discharge sheet. It also suggests that if a facility is visited by a large number of patients that have serious illnesses, the facility should focus on increasing the facilities for such patients.
How Are Payments Determined?
Medicare determines the compensation plan for a managed care organization by gathering its information and assigning individual codes to every disease they have treated. Medicare then uses the following four models to determine accurate reimbursement plan for it:
1. New enrollee model
2. Long-term care institution
3. End Stage Renal Disease
4. Community model
Documenting Information
In Medicare risk adjustments, for the sake of accuracy, the details are recorded in terms of medical charts. These documents can then be used for compliance purposes as well.
How to Report Data
Risk Adjustment Processing System (RAPS) is a program used to report data quarterly. The Centers for Medicare and Medicaid Services even offer training programs to ensure it is used effectively.
In addition this, the records of Medicare risk adjustment can be used by physicians to check which patients' documentations need to be completed before the year ends.
