Risk Adjustment

nloshaw@mhc.net

Risk adjustment and HCCs are a target for outpatient CDI right now, however, what if a facility does not use capitated payments?  This is where I am having a dilemma.  Our physician practices are paid based on a "cost based encounter rate" for RHC, therefore risk adjustment would not pertain to us from what I am told.  Do you have any insight on what organizations are doing as far as outpatient measures if they do not fall within capitation payment methods?  
Thanks

lprescott1

Outpatient CDI can focus on a number of different issues. You are correct risk adjustment is a primary focus. some work to assist their providers with documentation to support their pro fees (E&M). record reviews can also focus on charge capture for interventions performed or medical necessity of care. Also providers participating in quality reporting measures would benefit from both a risk adjustment focus and record review to assure measure criteria are being met.