10 ideas for a profitable business danger adjustment program

The Inexpensive Care Act (ACA) healthcare market is rising steadily, with over 21 million individuals enrolled in an ACA Market Plan in 2024 as extra plans proceed to enter the market. Health insurance coverage issuers with danger adjustment lined plans collaborating in HHS-RADV reached 76.4% in 2022, in comparison with 71.3% in 2021, according to data from the Middle for Medicare & Medicaid Companies. 

As we anticipate this development to proceed due in-part to the impression of Medicaid redetermination,  a dependable danger adjustment program is critical to seize member danger, safe acceptable risk-associated revenues, and enhance care supply and information.  

Current HHS-RADV audits from CMS revealed a number of extremely misdiagnosed HCCs, together with diabetes with continual problems and coronary heart arrythmias. Health plans contemplating getting into this market or increasing their present choices can discover ways to optimize the impression and compliance of their business danger adjustment packages to finest serve their members.  

Learn Cotiviti’s new business danger adjustment guidelines for suggestions to: 

• Enhance retrieval charges by amassing well timed and full information
• Decrease administrative expense
• Improve accuracy of coding outcomes to deal with annual audits 

Dive into our suggestions and classes realized from over 25 years within the danger adjustment house.  Cotiviti’s experience has led to constant high-quality outcomes, together with >98% coding accuracy throughout our business danger adjustment purchasers in 2023.

Don’t miss this chance to enhance your business danger adjustment program and put together for the 12 months forward.