Risk Adjustment levels the playing field by discouraging adverse selection of members through a two-step process: Risk Assessment, which evaluates the health risk status of an individual to create a clinical profile; and Risk Adjustment, which determines the resource utilization needed to provide medical care to an individual.
Accurate Medical Records
Providers play a critical role in helping ensure the integrity of the data used in calculating overall health risk by providing:
- Medical record documentation sufficient to support ICD-10-CM coding to the highest level of specificity for claim/encounter data submission and risk trends
- Adherence to ICD-10-CM industry and reporting coding guidelines for conditions that are monitored, evaluated, assessed or treated (MEAT)
- A comprehensive health status for each patient
- Accurate, ICD-10-CM coding for every patient, every time
Helpful Industry Links
Read more about the new Risk Adjustment, Reinsurance and Risk Corridors standards in the Federal Register .
Regulatory Overview/HHS Risk Adjustment Model