What is Risk Adjustment?

What is Risk Adjustment?

Risk adjustment is a newer payment methodology that is designed to allow for a proactive approach to managing healthcare. It does not seek to audit against current claims or encounters. It is a yearly collection of diagnosis codes to accurately build a total RAF (Risk...
The Importance of Getting Risk Adjustment Right

The Importance of Getting Risk Adjustment Right

Background Anyone who has taken the CRC™ (Certified Risk Adjustment Coder) curriculum can tell you that risk adjustment was first utilized in the mid-90’s for Medicaid purposes. The goal of risk adjustment has always been to collect data on patients so that money...

Targeted Probe and Educate (TPE) is Back

The tagline from the CMS Website is “When Medicare Claims are submitted accurately, everyone benefits.” First – TPE why do we even care?  Well, simple answer, it is a lovely little gift from CMS designed to help reduce claim denials and appeals through one-on-one...