I came across this excellent publication entitled
THE EVER-GROWING COMPLEXITY OF RISK SCORE CALCULATION – 2019 & BEYOND
by Gorman Health Group
Topics covered:
Risk Adjustment Overview
Data Submissions
• RAPS
• EDPS
• Transitional Impacts Cures Act on Risk Adjustment 2019 Risk Adjustment Model Changes
Cures Act on Risk Adjustment
2019 Risk Adjustment Model Changes
highlights, slide 8:
RAPS = Risk Adjustment Processing System Risk adjustment is the method used to adjust bids and payments to health plans based on demographics (e.g., age and gender) as well as actual health status of a plan’s enrollees. Medicare risk adjustment is prospective, meaning diagnoses from the previous year and demographic information are used to predict future costs and adjust payment.
and on slide 10:
EDPS = Encounter Data Processing System Encounter data is detailed data generated by healthcare providers, such as doctors and hospitals, which documents both the clinical conditions they diagnose as well as the services and items delivered to beneficiaries to treat these conditions. The Centers for Medicare & Medicaid Services (CMS) began collecting encounter data from Medicare Advantage plans in 2012.
web address:
https://www.cioxhealth.com/wp-content/uploads/Ever-growing-Complexity-of-Risk-Score-Calculation-Smith.pdf
THE EVER-GROWING COMPLEXITY OF RISK SCORE CALCULATION – 2019 & BEYOND
by Gorman Health Group
Topics covered:
Risk Adjustment Overview
Data Submissions
• RAPS
• EDPS
• Transitional Impacts Cures Act on Risk Adjustment 2019 Risk Adjustment Model Changes
Cures Act on Risk Adjustment
2019 Risk Adjustment Model Changes
highlights, slide 8:
RAPS = Risk Adjustment Processing System Risk adjustment is the method used to adjust bids and payments to health plans based on demographics (e.g., age and gender) as well as actual health status of a plan’s enrollees. Medicare risk adjustment is prospective, meaning diagnoses from the previous year and demographic information are used to predict future costs and adjust payment.
and on slide 10:
EDPS = Encounter Data Processing System Encounter data is detailed data generated by healthcare providers, such as doctors and hospitals, which documents both the clinical conditions they diagnose as well as the services and items delivered to beneficiaries to treat these conditions. The Centers for Medicare & Medicaid Services (CMS) began collecting encounter data from Medicare Advantage plans in 2012.
web address:
https://www.cioxhealth.com/wp-content/uploads/Ever-growing-Complexity-of-Risk-Score-Calculation-Smith.pdf
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