As last month’s issue of Network Matters highlighted, risk adjustment is one of the significant Affordable Care Act (ACA) reforms taking effect this year. The ACA’s risk adjustment program creates a mechanism to protect against insurer risk selection, promote market stability, and encourage competition on the basis of quality and value.
The ACA risk adjustment program measures and compares the relative health status among health plans’ membership by calculating average risk scores. Since the accuracy of these risk scores is dependent on complete and accurate reporting of diagnoses by physicians, risk adjustment creates an opportunity for health plans and providers to review coding practices and identify and correct common coding gaps.
As part of our efforts to increase awareness about risk adjustment and complete and accurate coding, Harvard Pilgrim has developed a brief audiovisual presentation for providers, which is currently available on our provider website.