Top Risk Adjustment Tools Every Healthcare Plan Should Know

1. Top Risk Adjustment Tools Every Healthcare Plan Should Know Risk adjustment tools are critical for healthcare plans, as they help estimate the cost of treating a patient in a given year, based on their specific health needs. This helps ensure that health plans are compensated appropriately – creating a weighted system for those who require more or more costly services. Additionally, this enables the providers to treat patients with different needs and not just healthier, less costly patients. Here are some of the top risk adjustment tools healthcare plans should have at the ready. Coding Tools Medical coding plays a key role in risk adjustment, as it creates a consistent and quantifiable measurement and categorization of the medical needs of a specific patient. A medical coder takes the physician’s notes, codes them appropriately, and enters them into a database or spreadsheet for record-keeping, compliance, reporting, and more. These codes are used to determine the risk adjustment score – also known as the risk adjustment factor (RAF) – of that patient. Coding helps create a more accurate record of a patient’s health, which in turn helps get more accurate risk adjustment scores. If your team is working out of a spreadsheet or an antiquated system that does not provide reporting or customization, this process is strenuous and can leave you open to compliance issues. Using a tool like our Episource Coder helps to reduce the manual labor involved and mitigates compliance issues. Chart Reviews Getting another set of eyes on your work for quality assurance is never a bad idea. That is why conducting regularly scheduled chart reviews and audits are important risk adjustment tools that can help catch and clean errors and discrepancies, improving the accuracy of your data. Finding internal bandwidth to conduct these audits can be difficult for healthcare professionals, and having a knowledgeable team conduct these is paramount. This is why we provide Chart Audits – to validate proper coding, identify coding without supporting documentation, and ensure that claims are substantiated by clinical data from the medical record. This blog is originally published here: https://www.episource.com/resources/top-risk-adjustment-tools-every- healthcare-plan-should-know/