2018 Managed Care Compliance Conference Guest Blogs: Risk Adjustment (It’s Not For the Faint of Heart)

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By Larry Pliskin

Risk adjustment sounds so simple . . . you get paid more for members who are sicker (as long as you have it well documented) and paid less for members who are not as sick. But the convoluted methodology currently in place to collect relevant data, submit that data and have that data processed by CMS is fraught with potential errors and almost always is confusing. Fortunately, I just attended a terrific session at this year’s HCCA Managed Care Compliance Conference. The presenters did a great job of helping to explain this complicated topic. The gist of the presentations was to be strategic about your risk adjustment program. Be careful in assessing the risk to your organization in this area. Be deliberate about training your people. Be vigilant in auditing and monitoring your staff. And, continue to learn as much as you can about this complicated area of the managed care world. After today’s session, I feel a little more knowledgeable and a lot more confident — so thank you to HCCA for sponsoring this amazing conference.

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