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Risk Adjustment
Overview
Risk adjustment is a prediction strategy for evaluating individuals' healthcare outcomes or expenses that takes into consideration their underlying health condition and health spending. It is a statistical method for predicting healthcare expenses.
Challenges
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Risk determination is difficult
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Lot of data is required in Risk Adjustment
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Coding errors are common
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Leading to Revenue Leakage
Solutions
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Denials Analysis
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Denials Management
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Effective Eligibility Verification
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Timely Follow-up
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Operational Rigor
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Feedback loop
Capability
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Prospective Risk Adjustment
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Retrospective Risk Adjustment
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Concurrent Risk Adjustment
Results
Consistent & uncompromised
95%
+
coding accuracy
Continuous
Best
in Class
audit processes
Dedicated
&
Experienced Workforce
95%
adherence to guidelines
