To improve revenue, which approach should a Medicare Advantage Plan adopt?

The answer is considered optimal because developing both a prospective and retrospective review allows a Medicare Advantage Plan to thoroughly analyze and validate the accuracy of the diagnoses represented in patient records. This comprehensive approach ensures that all relevant diagnoses are properly documented and coded, which is crucial for accurate risk adjustment and reflects the true health status of members. By systematically identifying any gaps in coding through these reviews, a plan can enhance its revenue streams effectively since reimbursement is often tied to the accuracy and completeness of reported diagnoses.

Engaging in this kind of in-depth review not only maximizes the plan's chances of capturing appropriate diagnoses but also helps to establish a culture of continuous improvement in data quality, thereby positioning the plan favorably within the risk adjustment framework. This dual method fosters a proactive stance on data management, addressing both current records and historical data to achieve a well-rounded understanding of patients' health profiles.