Risk adjustment means an actuarial tool used to calibrate premiums paid to health benefits plans or carriers based on geographical differences in the cost of health care and the relative differences in the health risk characteristics of employees, annuitants, and family members enrolled in each plan. Risk adjustment establishes premiums, in part, by assuming an equal distribution of health risk among health benefits plans in order to avoid penalizing employees, annuitants, and family members for enrolling in a health benefits plan with higher than average health risk characteristics.
Risk adjustment means the process by which relative risk factors are assigned to individuals or groups based on expected resource use and by which those factors are taken into consideration and applied.
Risk adjustment means the compensation that would be required for bearing uncertainty about the amount and timing of the cash flows that arise from non-financial risk.
Examples of Risk adjustment in a sentence
Risk adjustment data are all data that are used in the development and appli- cation of a risk adjustment payment model.
Risk adjustment is the process used by CMS to adjust the payment made to the Medicare Advantage Organization based on the health status of the Medicare Advantage Organization’s Medicare Advantage members.
Risk adjustment was implemented to pay Medicare Advantage Plans more accurately for the predicted health cost expenditures of members by adjusting payments based on demographics (age and gender) as well as health status.
Risk adjustment establishes premiums, in part, by assuming an equal distribution of health risk among Health Benefits Plans in order to avoid penalizing Enrollees for enrolling in a Health Benefits Plan with higher than average health risk characteristics.
CMS may add to, modify, or substitute for risk adjust- ment factors if those changes will im- prove the determination of actuarial equivalence.(2) Risk adjustment: Health status—(i) Data collection.
More Definitions of Risk adjustment
Risk adjustment. A methodology to account for the health status of enrollees via relative risk factors when predicting or explaining costs of services covered under the contract for defined populations or for evaluating retrospectively the experience of MCOs contracted with the State.
Risk adjustment means the compensation an insurer requires for bearing the uncertainty about the amount and timing of the cash flows that arises from non-financial risk as the insurer fulfils its insurance contracts;
Risk adjustment means an actuarial tool used to calibrate premiums paid to health benefits plans or carriers
Risk adjustment. An actuarial tool used to calibrate premiums paid to Health Insurance Issuers based on geographical differences in the cost of health care and the relative differences in the health risk characteristics of Enrollees enrolled in each plan. . Risk adjustment establishes premiums, in part, by assuming an equal distribution of health risk among Health Benefits Plans in order to avoid penalizing Enrollees for enrolling in a Health Benefits Plan with higher than average health risk characteristics.
Risk adjustment. MEANS AN ADJUSTMENT TO THE PAYMENT FOR PRIMARY CARE SERVICES THAT IS DETERMINED BY QUANTIFYING A PATIENT'S COMPLEXITY BASED ON OBSERVABLE DATA, ADDRESSING THE TIME AND EFFORT PRIMARY CARE PROVIDERS SPEND IN CARING FOR PATIENTS
Risk adjustment. MEANS AN ADJUSTMENT TO THE PAYMENT FOR PRIMARY CARE SERVICES THAT IS DETERMINED BY QUANTIFYING A PATIENT'S COMPLEXITY BASED ON OBSERVABLE DATA, ADDRESSING THE TIME AND EFFORT PRIMARY CARE PROVIDERS SPEND IN CARING FOR PATIENTS OF DIFFERENT ANTICIPATED HEALTH NEEDS, AND INCLUDING SOCIAL FACTORS SUCH AS HOUSING INSTABILITY, BEHAVIORAL HEALTH ISSUES, DISABILITY, AND NEIGHBORHOOD-LEVEL STRESSORS.
Risk adjustment a methodology applied to the rate setting process to account for the health status of enrollees via relative risk factors when predicting or explaining costs of services covered under the contract for defined populations or for evaluating retrospectively the experience of MCOs contracted with the State. Risk adjustment uses information on an enrollee’s medical conditions, as reported in claims data, to predict health care costs and adjust payments to MCOs. Risk adjustment helps ensure payments to MCOs are more equitable and mitigates the impact of selection bias, thus protecting MCO solvency and reducing incentives for plans to avoid high-risk individuals. Risk adjustment is designed to be budget neutral to the State. Routine Care – basic primary care services including the diagnosis and treatment of conditions to prevent deterioration to a more severe level, or minimize/reduce risk of development of chronic illness or the need for more complex treatment. Service Authorization – (also Prior Authorization); includes an enrollee’s request for the provision of a service. Skilled Nursing Care – services from licensed nurses in a enrollee’s own home or in a nursing home. Specialist – a provider who focuses on a specific kind of health care, such as a surgeon or a cardiologist. Start Date – the date the Contract for services becomes effective. Subcontract – any written agreement between the MCO and another party to fulfill any requirements of this Contract. Subcontractor – party contracting with the MCO to perform any services related to the requirements of this Contract. Subcontractors may include, without limitation, affiliates, subsidiaries, and affiliated and unaffiliated third parties. Subcontractor Monitoring Plan – a written plan describing how obligations, services, and functions performed by the MCO's Subcontractor will be reviewed to ensure that such obligations, services, and functions are performed to the same extent that they were performed by MCO. Supplemental Security Income (SSI) – a Federal income supplement program designed to help aged, blind, and disabled people with little or no income by providing cash to meet basic needs for food, clothing, and shelter. Systems Quality Assurance Plan – a written plan developed by the MCO that describes the processes, techniques, and tools that the MCO will use for assuring that the MCO information systems meet the Contract requirements. Temporary Assistance to Needy Families (TANF) – the federally funded p...