by RISE
21. December 2011 19:20
By RaeAnn Grossman, Senior Vice President, Gorman Health Group
Ask Yourself: What would my 2012 member assessment strategy and timing look like if I want to look like a Risk Adjustment Super Hero?
Step 1: Compile Data in February
Step 2: Launch Member Evaluation in March
Step 3: Complete 50% of Your Member Evaluations by June 30th
Step 4: Reduce Dependence on Chart Review to .30 Charts per Member and Increase Member Evaluations to 85% of the Membership (for PFFS, PPO, and HMO Plans)
Step 5: Refine Analytics and Reduce Zero HCC Member Evaluation Percentage (should always be less than 30%, but you want to push toward 15% if you are not reviewing your entire population)
Step 6: Check Year Over Year Revenue Increase January - June and July - December for Member Evaluations to Ensure ROI and Payment Reconciliation
