Risk adjustment plays a crucial role in healthcare by ensuring that reimbursement reflects the true cost of care for patients with complex medical needs. However, current risk adjustment solutions face several challenges that hinder their effectiveness. These challenges include inaccuracies and hurdles in the following aspects. Let’s find out!
Current Challenges in The Risk Adjustment Solution
1. Accuracy and Completeness of HCC Coding
Issue: Inaccurate or incomplete Hierarchical Condition Category - HCC coding leads to under or overestimation of risk scores.
Impact: Affects reimbursement and care planning for patients, leading to financial losses and suboptimal care