If I want a Risk Adjustment Super Hero ….

December 20, 2011
|In Risk Adjustment
|By GHG Advisors

Ask yourself: What would my 2012 member assessment strategy & timing look like if I want a Risk Adjustment Super Hero?

  • Step 1: Compile data in February
  • Step 2: Launch member evaluations in March
  • Step 3: Complete 50% of your member evaluations by June 30th
  • Step 4: Reduce dependence on chart review to .30 charts per member and increase member evaluations to 85% of  the membership (for PFFS, PPO, and HMO plans)
  • Step 5: Refine analytics and reduce zero HCC member evaluation percentage (should always be less than 30% but you want to push toward 15% if you are not reviewing your entire population)
  • Step 6: Check year over year revenue increase Jan — June and July —December for member evaluations to ensure ROI and payment reconciliation