Jul 13, 2023 | Healthcare Compliance
In our previous article, we explained how Risk Adjustment is a “partnership” between the patient, the provider, the insurance plan (Plan), and the governmental entity. So, which partner in this process holds the “risk”? Governmental Entity: The governmental entity has...
Jul 5, 2023 | Healthcare Compliance
Under the risk adjustment (RA) model, reimbursements to the insurance companies (Plans) are based on the member’s level of severity of illness rather than the number and types of interventions the member receives throughout the year. This reimbursement model is based...
