Risk Adjustment Workflow Best Practices

When the Affordable Care Act was passed in 2010, it included a section (1343, to be exact) that provided a permanent risk adjustment program to lessen or, in a perfect world, eliminate the influence of risk selection on the premiums that health plans could charge, and an include an incentive for those health plans to avoid sicker and/or chronic enrollees. More specifically, when the risk adjustment program was first established, the goals of the program were two-fold:

• • Mitigate the impacts of potential adverse selection
  • Stabilize premiums in the individual and small group markets

But, since it’s passing and eventual implementation in 2014, the risk adjustment program has faced a variety of challenges. Specifically, CMS has identified three challenges they faced in developing the HHS risk adjustment methodology, which included “1) new populations 2) cost and rating factors, including plan actuarial value levels and permissible rating factors, and 3) balanced transfer payments among health plans.” For those of us living and working in the healthcare field, over the years we’ve uncovered our own challenges to implementing and remaining compliance with the risk adjustment program. I for one encounter more than my fair share of headaches throughout the process of submitting your claims.

Whether you're a small or large healthcare organization, identifying missed opportunities and increasing your recapture rate can be a huge challenge. Or, if you work for a health plan, documentation retrieval and antiquated technology may be your biggest struggle.

So, how do you overcome these obstacles?

Simple. On Wednesday, July 14, 2021 our resident Risk Adjustment and workflow expert, Jennifer Hill, will be hosting a new webinar, “Solutions for Your Risk Adjustment Workflow Struggles,” where she’ll help you:

• • Identify New Ways to Mitigate Risk Adjustment Roadblocks
  • Walk Through a Value-based Workflow, from Implementation to Claim Submission
  • Introduce Tech Solutions You Can Leverage to Improve Your Workflow