PPT-Risk Adjustment Concepts

An Introduction and Discussion MAPAM March 16 2017 Agenda Risk Adjustment How Risk Adjustment Works Risk Adjustment Factor RAF Scoring Process Comprehensive Annual Visits Predictive Modeling amp Quality of Care. g gym memberships and exercise classes Medicare Advantage plan receives payment for each member from CMS Payment is based on member predicted health status and demographic characteristics Medicare Advantage plan regulated by CMS brPage 6br Introducti Colorado Division of Insurance. Risk Adjustment Question. Who should administer Risk Adjustment in Colorado?. Federal Government; or. State Government:. Use Federal Model (2012 Exchange Bill says to “strongly consider”). Does Your Plan’s Risk Adjustment Strategy . Violate the. False Claims Act?. August . 27, . 2015. Phillips & Cohen LLP. www.phillipsandcohen.com. 2. Overview of Risk Adjustment Fraud. Risk adjustment fraud is essentially “upcoding” for diagnosis codes. Socioeconomic Status;. Linking Cost and Quality Measures. HSCRC . Performance Measurement . Workgroup. May 28, 2014 . Tom Valuck, MD, JD. Presentation. . Overview. U. pdate . the . Performance Measurement Workgroup . Socioeconomic Status;. Linking Cost and Quality Measures. HSCRC . Performance Measurement . Workgroup. May 28, 2014 . Tom Valuck, MD, JD. Presentation. . Overview. U. pdate . the . Performance Measurement Workgroup . Americas. . Randall P. . Ellis. 1. Juan Gabriel Fernandez. 2. 1. Boston University. 2. University of Chile and Chile Ministry of Health. . Presentation prepared for the V . Congreso. . Economia. de la . A Work Plan for State Officials. December 2, 2011. Ross Winkelman, FSA Mary Hegemann, FSA and Syed Mehmud, ASA. Contributions by Tom Leonard, James Woolman, Julie . Peper. , and Patrick Holland. Caveats. Risk adjustment. Program establish by Centers for Medicare and Medicaid Services [CMS]. GOAL. : to allocate resources to those patients who most need them, based on each patient’s severity of illness. Cynthia Trapp, MS,CHFP, CMPE, CPCO, CPC, CPC-I, AAPC-Fellow, CCS-P, CHC. New England MGMA Regional Conference. Friday May 4, 2018. Defining Risk Adjustment. History of CMS Risk Adjustment. Risk Adjustment Models. Risk Adjustment and Reinsurance RARI Interface Control Document Risk Adjustment Data Validation RADVAddendumMarRisk Adjustment and Reinsurance RARI Interface Control Document Risk Adjustment Data Vali Alice B. Torrez MHA, CPC. Educator Coding and Documentation. Health Information Management. University of New Mexico Hospital. 2. View of Risk Adjustment. Are my patients . sicker?. These numbers are not right…. Kennell. & Associates. Objectives. Describe the DHA Risk Adjustment Model. Provide an overview of the Clinical Conditions and how they are used in the Risk Adjustment Model. Highlight key fields. Does . your . plan’s strategy violate the False Claims Act?. Phillips & Cohen LLP. www.phillipsandcohen.com. 2. Overview of Risk Adjustment Fraud. Risk adjustment fraud is essentially “upcoding” for diagnosis codes. Linking Cost and Quality Measures. HSCRC . Performance Measurement . Workgroup. May 28, 2014 . Tom Valuck, MD, JD. Presentation. . Overview. U. pdate . the . Performance Measurement Workgroup . on NQF .