What is risk adjustment?
Risk adjustment is a reimbursement model that funds health plans based on patient health risks.
The Centers for Medicare & Medicaid Services (CMS) created this payment model to ensure patients with complex health conditions have equitable access to necessary resources and care. The model:
- Identifies patient needs based on their risk profiles, helping providers to develop care plans.
- Assigns each enrollee a risk score based on their health status and other factors. A higher risk score indicates a higher likelihood of needing more health care services.
- Uses certain ICD-10 diagnoses codes reported by clinicians to calculate risk adjusted reimbursements.
Providers can support risk adjustment by identifying and addressing risk-related care gaps and documenting them accurately in each patient’s medical record. This way, an Alliance members’ health status is correctly documented.
Incentives for providers
The Alliance Risk Adjustment Coding & Documentation Accuracy Incentive Program is designed to support providers with addressing chronic conditions and improving health care outcomes for Alliance members. The program helps ensure patients are scheduled annually for a comprehensive visit and supports providers with managing chronic health conditions.
To learn more about the program, visit our webpage. We also have trainings and webinars about the program available for your review.
Introducing Cozeva: Point-of-care solutions for better patient outcomes
selected Cozeva as its point-of-care solution system to help facilitate information to CMS and support risk adjustment. For all other providers, if you have questions about Cozeva implementation or want to know more about this program please reach out to your designated Provider Services representative.
What does Cozeva do?
Cozeva assists providers during patient interactions. The point-of-care tool provides instant access to patient information, so providers can make informed clinical decisions promptly, identify gaps in care and capture health data accurately.
This system helps providers deliver high-quality, personalized care by displaying potential conditions a patient may have.
. These reviews provide insights into areas where additional coding and documentation training is needed, creating higher quality documentation of the patient’s true clinical status and treatment.
