What is one way plans can improve their risk adjustment process?

Plans can improve their risk adjustment process by ensuring that all codes submitted are supported by appropriate medical documentation. Accurate coding is essential in risk adjustment as it reflects the true health status of the population being served. When a plan ensures that each diagnosis code corresponds to adequate documentation from the medical records, this increases the reliability of the data used for risk adjustment.

Moreover, appropriate documentation supports the legitimacy of the submitted claims during audits and helps in achieving a higher level of compliance with regulatory requirements. This process can lead to a more accurate recalibration of risk scores, which ultimately affects reimbursement rates and the quality of care provided to members.

Improving documentation practices not only strengthens a plan's risk adjustment strategies but also enhances overall clinical care by ensuring that the health status of members is fully captured and understood. This results in better health outcomes and more effective resource allocation within the healthcare system.