Risk Adjustment: Are you driving a Pacer or an Audi R8?

December 6, 2011
|In Risk Adjustment
|By GHG Advisors

How can you tell if your risk adjustment program is a high performance machine?
Here is the quick test:

1. Did you hit your volume target for member evaluations for 2011?
2. Did you hit your revenue target for chart review and member evaluations for 2011?
3. Are you planning for a 2012 Quarter 1 launch for member evaluations?
4. Do you have best in class analytics with a constant 5 to 1 ROI or higher for member evaluations?
5. Are you reducing your dependence on chart review?
6. Are you scrubbing your claims based HCCs for validation & confidence levels?
7. What is your percentage of zero HCCs found in your member evaluation program?
8. What is your percentage of zero HCCs found in charts?
9. Do two different coders agree on your findings?
10. Are any of your vendors on corrective action plans with you?

We have a few more questions for you. If you want to morph your program into a high performance machine, now is the time for best practices discussion, strategic planning, and program improvement.