Best Practices to Maintain Accuracy with Medicaid Billing Risk Adjustments Jul21


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Best Practices to Maintain Accuracy with Medicaid Billing Risk Adjustments

Providing healthcare services within a managed care system is not without its challenges, especially when it comes to Medicaid markets. One of these challenges is Medicaid risk adjustment, which can vary from each state.

This makes it difficult for a managed care organization to run a program that fits across multiple states. With that said, applying the following best practices may help the organizations improve accuracy outcomes when a risk adjustment becomes necessary.

1. Empower Providers with Actionable Data

One way to maximize your efforts in making risk adjustments is to make sure all providers receive prompt information at the point of care. By doing so, a patient receives a full assessment and avoids being either misdiagnosed or not diagnosed at all for a health condition.

2. Encourage Patients to Schedule Preventive and Wellness Visits

Another way to close gaps in care is to engage patients with preventive and wellness appointments. Regular visits can help providers provide more accurate diagnoses and documentation, which minimizes Medicaid risk adjustment incidents. By educating patients on the health benefits of these visits, they may become more engaged in the care they receive.

3. Ensure Providers Identify All Health Conditions

Improving accuracy outcomes for Medicaid risk adjustment also involves identifying all health conditions and correctly coding those conditions. With complete and accurate details, states have better records to compare and assess risk scores for health plans.

Implementing these three best practices helps to close gaps in care, which is the primary goal of having a risk adjustment program.

Get Guidance on an Effective Risk Adjustment Program

When you find ways to improve patient health care outcomes, you may also improve risk scores. These improvements translate to a healthy bottom line. GeBBS Healthcare Solutions specializes in solving these types of challenges. Go to the website to learn more about how they can help.

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