Risk Adjustment

Risk adjustment is the methodology utilized by CMS allowing health care providers to be appropriately reimbursed based on the documented burden of illness of their patient population. Providers justify their patient population resource needs through accurate documentation and coding. Our risk coding team provides documentation and coding education for all Mount Carmel and associated independent providers using up-to-date CMS and RADV audit standards. Our documentation and coding review results are shared annually with each practice 1:1. This process creates a more easily digested, provider tailored education where providers can see where they exceed and where there is room for improvement.