The Centers for Medicare and Medicaid have created and been using a risk adjustment program that is used to help regulate the quantity of payments to be given to members using the Medicare Advantage plan. Medicare Advantage utilizes a formula that takes into account various diagnostic data and client history in order to calculate the risk factors of a member. When put into simple terms, this risk adjustment formula takes the client's health concerns and puts a price tag on how much each issue will likely cost the private health care plan over a period of time. Risk adjustment has been used within Medicare and Medicaid for a long period of time and is continually being bettered and researched.
Through this model the financial risk factor of each member is determined by looking at factors such as client history, diagnostic data as well as age and current health status. The risk factor of each plan member is the number, or cost, that they are likely to incur over the time span of one year. Risk adjustment is often used in the health insurance field and has been used by the Centers of Medicare and Medicaid services for numerous years and is persistently being developed and bettered.
Being able to correctly estimate what the cost of care for a particular plan member is likely to be, is an important part in making a productive risk adjustment model. The Medicare risk adjustment model uses the information they gain through the client's health plan and claims data as a way to develop the estimated cost. This means that the health insurance companies play an integral part in helping to keep the costs of the Medicare program correct as it is the foremost source of information used to base the payments off of.
Since so much of the information gained from claims reporting is used to base the Medicare risk adjustment numbers off of the significance of correct claims reporting by the health insurance and health care suppliers is very high. Detailed and correct reporting will help to produce more correct numbers and decrease the quantity of mistakes. A number of mistakes that usually occur with this model are due to the reporting done during client interactions and visits as well as the level of communication between health care suppliers, insurance companies and CMS.
In order to get a proper risk adjustment for each individual client, health care suppliers and private health insurance plans will need to pay closer attention to the recording of each client encounter and application of the necessary diagnostic codes.
Through this model the financial risk factor of each member is determined by looking at factors such as client history, diagnostic data as well as age and current health status. The risk factor of each plan member is the number, or cost, that they are likely to incur over the time span of one year. Risk adjustment is often used in the health insurance field and has been used by the Centers of Medicare and Medicaid services for numerous years and is persistently being developed and bettered.
Being able to correctly estimate what the cost of care for a particular plan member is likely to be, is an important part in making a productive risk adjustment model. The Medicare risk adjustment model uses the information they gain through the client's health plan and claims data as a way to develop the estimated cost. This means that the health insurance companies play an integral part in helping to keep the costs of the Medicare program correct as it is the foremost source of information used to base the payments off of.
Since so much of the information gained from claims reporting is used to base the Medicare risk adjustment numbers off of the significance of correct claims reporting by the health insurance and health care suppliers is very high. Detailed and correct reporting will help to produce more correct numbers and decrease the quantity of mistakes. A number of mistakes that usually occur with this model are due to the reporting done during client interactions and visits as well as the level of communication between health care suppliers, insurance companies and CMS.
In order to get a proper risk adjustment for each individual client, health care suppliers and private health insurance plans will need to pay closer attention to the recording of each client encounter and application of the necessary diagnostic codes.
Ditulis oleh:
Unknown - Monday, October 1, 2012
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