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RISK ADJUSTMENT

How to stay sharp during commercial risk adjustment season

As the commercial risk adjustment season launches, health plans face the challenge of ensuring appropriate reimbursement while also maintaining compliance. But by fully understanding your members as well as the various data exchanges that take place along the risk adjustment continuum, you’ll have a sharp tool set at your disposal to manage this effectively. 

I hope you’ll join me for an upcoming Cotiviti webinar on Thursday, March 7, at 2:00 p.m. ET. I’ll take you through several best practices on how to approach and manage your commercial risk adjustment program for successful outcomes, as well as recap the most important regulatory developments of 2018. 

Here’s a quick preview of what you’ll learn:                   

  • Tips for ensuring the accuracy of plan and submissions data: Each of the areas supporting risk adjustment has its own set of challenges and complications. In addition, the accuracy of rollover, off-exchange (RBIS), on-exchange, and retired plans have continued to be a problem for health plans from year to year. We’ll look at how to review and analyze plan data prior to starting submission, and discuss the importance of ensuring cross-functional expertise across the entire process to identify leakage and resolve issues that can occur at any point.
  • Tools for enabling high-quality member-provider connections: By employing suspect analytics, organizations can better identify, prioritize, and target members and conditions with the highest probability of being undocumented. We’ll examine different engagement methods, as well as tools such as incentives to encourage members to visit their primary care providers and for providers to engage with the member’s wellness plan.
  • Methods for improving retrieval and coding efforts: Common provider errors such as lack of code specificity or incomplete medical records can make a huge difference in revenue—and an even bigger difference if you’re audited. We’ll discuss tools such as data-driven provider education and improvement tracking that can reduce these costly mistakes.

I’ll also take some time to answer your questions directly. Don’t miss this vital information as you head into the toughest time of year for your commercial risk adjustment program.

Register for the webinar

WRITTEN BY

Rebecca Darnall
Rebecca provides leadership and oversight into new product and business development, growth, and strategy to assist health plans in the optimization of revenue and risk mitigation. With more than 15 years of healthcare experience, she is known for creating and establishing solid operating policies and procedures for all risk adjustment programs that comply with CMS requirements and industry practices. Prior to Cotiviti, Rebecca was a manager of risk adjustment strategy and performance solutions at Tessellate, a healthcare optimization company serving health plans and providers. In this role, she was responsible for the revenue accuracy and risk adjustment efforts for all lines of business for Blue Cross Blue Shield of Michigan.

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