Risk Adjustment Analytics For Accurate Reimbursement
Healthcare providers know the frustration: treating complex patients while getting paid as if they were healthy. Risk Adjustment changes this by matching payments to patient health status. When a provider treats someone with multiple chronic conditions, they get reimbursed accordingly. Analytics platforms now handle the heavy lifting of identifying these conditions and calculating proper payment levels. What is Risk Adjustment and Why Does it Matter? Risk Adjustment accounts for patient health differences when calculating insurance payments. Sicker patients cost more to treat, so providers should receive higher payments for their care. The payment structure works like this: A patient with documented diabetic complications generates higher Medicare Advantage payments End-stage renal disease codes boost reimbursement rates substantially Psychiatric conditions with proper documentation increase risk scores Multiple chronic conditions create cumulative ...
