The Year 2021 Brings New Trends Of Risk Adjustment Solution

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The Year 2021 Brings New Trends Of Risk Adjustment Solution

Risk Adjustment solutions predict if the health cost of a particular patient or group of patients is more or less than the general population. This prediction helps in adjusting the payments accordingly. Risk adjustment (RA) compensates both health plans and care providers for sicker patients. It also decreases their incentives for selecting healthier or cost-effective patients. The Risk Adjustment model considers the health risk of recipients by using numerous health variables, including recipients’ demographic features, social determinants of health, and the diagnosis. Medicare Advantage (MA), also known as Part C plans, is a part of the Medicare program for older people and disabled adults who qualify to receive social security. Private insurance companies offer MA Plans instead of the federal government. These plans demonstrate the benefits of the private sector’s innovative ideas for government-run Medicare Plans. The Centers for Medicare & Medicaid Services (CMS) is committed to reinforcing MA Plans by facilitating better innovation, accountability, adaptability, and functionality of health plans. It is becoming necessary for healthcare providers to identify care gaps and ensure accurate payer-agnostic data to build a multi-payer system more patient-centric. It also requires checking risk adjustment scores,


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