Risk adjustment is a healthcare payment model that reimburses health plans that disproportionately attract higher-risk populations (such as individuals with chronic conditions) by transferring funds from insurers with relatively lower-risk enrollees. In risk adjustment covered plans, an actuarial tool is used to predict health care costs based on the relative actuarial risk of enrollees.
The goals of risk adjustment are to mitigate the impacts of potential adverse selection (e.g., insurers refusing coverage to higher-risk individuals), and to stabilize health insurance premiums so that premiums better reflect differences in benefits and plan efficiency, rather than the health status of the enrolled population.
Prepare for certification and a career with Risk Adjustment training
Validate your knowledge, skills, and expertise with Risk Adjustment certification
03/05/2019 | Read More
02/27/2019 | Read More
01/14/2019 | Read More
04/13/2018 | Read More
cathy reidy, 03/22/2019
Contact us at 800-626-2633.
Call 877-290-0440 or have a career counselor call you.
Call 877-524-5027 to speak with a specialist.