What is Risk Adjustment?
The Risk Adjustment department manages LaSalle’s Medicare senior population throughout the State of California.
Risk Adjustment Factor (RAF) is a statistical process that is currently used by the Centers for Medicare & Medicaid Services (CMS) to calculate funding by predicting a patient's likely use and costs of health care services.
The senior population tends to encounter more illness and injuries annually. Because of this, capturing the proper Hierarchical Condition Category (HCC) codes and proper medical record documentation is paramount to ensure accurate RAF scores are calculated for all patients during their Annual Wellness Exam. When accurate RAF scores are calculated, proper funding will be provided to help with patient care.
By working with Coding and Nursing experts from the Health Plans, we have assisted with coordinating training and educational sessions. Some of the largest Federally Qualified Health Centers in the Central Valley have participated and benefited from the information shared during these trainings. These sessions provide the education, tips, and feedback needed to ensure the providers understand the importance of capturing the proper HCC coding and accurately documenting the encounter with the patient as it significantly impacts the overall RAF score.
Additional resources have also been provided by our Brand New Day health plan such as frequent virtual meetings and training sessions for HCC coding. In addition, LaSalle has provided HCC coding reference guides that providers can utilize when rendering services to our Medicare population.
If you have any further questions, contact us.