How Does Risk Adjustment Minimize Revenue Loss and Compliance Risk?
Healthcare providers in value-based payment contracts deal with two major financial threats: lost revenue from understated patient risk scores and regulatory fines from documentation failures. Risk Adjustment controls how much insurers pay providers by measuring how sick their patients are. Document patient conditions incorrectly, and payments drop. Skip the required documentation, and auditors come knocking. Getting risk adjustment right means your facility gets paid fairly for the patients you treat and stays clear of compliance problems. What is Risk Adjustment and Why Does It Matter? Risk Adjustment calculates what providers get paid based on how sick their patients are. Treating someone with multiple chronic diseases costs more than treating a healthy person, so insurers pay more for sicker patients. The system reads diagnosis codes from medical charts and assigns each patient a risk score. Incomplete Documentation Leads to Revenue Loss Providers lose revenue when they do...