RaeAnn Grossman.

OnStar for Risk Adjustment: Are you Okay?

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Did you just hit something – a bump in the road or another car? Is there a calm voice coming from your car, asking if you are okay? 

If only there were OnStar for risk adjustment.  It is almost year end and if there were an OnStar for risk adjustment this is what she would be asking you today:

• Do you have at least 75% of your chart review done?
• Is your coding accuracy over 85%?
• Do you have at least 70% of your member evaluations completed?
• Have you scrubbed your claims based HCCs for validity or code confidence?
• Have you checked the health plan RAPs filtering process, not just for duplicate, but for complete compilation?  Put another way – have you reconciled all the codes from your claims, chart review, and evaluations in the RAPS submission?
• Do you have a strong reconciliation process to ensure accurate payment when you get your RAPS return?
• Do you have an EDPS plan in place?
• Are you moving from retrospective chart review to current year chart review for 2012?
• Are you reducing your chart review strategy for 2012 and replacing it with member evaluations?
• Have you combined your member evaluations with your wellness exam criteria?
• Are you improving member outcomes and your HEDIS & STARS score with your integration of risk adjustment findings?
• Are you tracking the closing of your members’ gaps in care?

If you need some roadside risk adjustment assistance, now is the time to ask.

RaeAnn Grossman.

About RaeAnn Grossman.

RaeAnn Grossman is one of the nation’s foremost experts on risk adjustment strategies and provider and payer alliance configurations, along with healthcare business and product development. She brings Gorman Health Group more than twenty years of professional experience in a wide variety of healthcare organizations including Health Plans, Medical Groups, Physician Hospital Organizations (PHOs), Integrated Hospital Systems, and Institute of Health Professionals Education. Read more

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