What is Risk Adjustment Coding?
“Risk adjustment is a method to offset the cost of providing health insurance for individuals—such as those with chronic health conditions—who represent a relatively high risk to insurers. ... Risk adjustment models typically use an individual's demographic data (age, sex, etc.) and diagnoses to determine a risk score.” –AAPC
Risk adjustment coding is a critical component of both the healthcare and expected medical costs of Americans. And accurate documentation and coding is the most critical component of the whole risk adjustment process. Basically, accuracy is king.
History of Risk Adjustment Coding
Risk adjustment was first implemented back in 2000 when CMS began using inpatient diagnostic data. In 2004, CMS then improved their own accuracy to allow for the addition of professional encounter data for chronically ill people. Then, more recently, the Affordable Care Act continued the evolution of risk adjustment by bringing it to individual and employer markets in 2014. In a relatively short amount of time, risk adjustment has gone from being an early adopter of healthcare data into perhaps the single most important aggregator of healthcare data. And it’s not slowing down.
How to Excell or Get Started
But if you’re already working in a risk adjustment program, how do you know if you’re getting the most out of it? And if you are not working in a risk adjustment program, where do you even begin?
Tune into our upcoming webinar, The Past, Present, and Future of Risk Adjustment, this Wednesday, June 26th, to learn how you can leverage best practices to implement risk adjustment, use risk adjustment to increase your revenue, and know where risk adjustment is headed to stay ahead of the curve.