As health care providers and Medicare Advantage (MA) plans strive to provide better care to beneficiaries, they are constantly looking for ways to better leverage their financial resources to maximize their own returns while freeing up more budget for their members. One way to do this is to calculate the Medicare Risk Adjustment (MRA).
Read on as we look at how MRA calculators can help maximize MA payments and enable providers to provide better service to their members.
Guide to Medicare Risk Adjustment
Medicare Risk Adjustment is a payment model used to increase or decrease payments for MA plans based on the health status of enrollees. This model uses a risk score to adjust payments based on the expected costs of care for their beneficiaries.
To do this, the MRA model takes into account demographic and clinical data, including age, gender, diagnoses and other health-related factors, to determine a user’s risk score. The higher the degree of risk, the higher the payment to the MA plan.
Why use MRA calculators?
MRA calculators such as the Medicare Risk Adjustment Calculator are used by health analysts and auditors from health facilities and MA plans to estimate risk scores and payments for individual beneficiaries so that they can accurately estimate the expected cost of care for each beneficiary and adjust their care plan accordingly.
Maximizing MA Payments with MRA Calculators
MRA calculators can help health care providers and MA plans fine-tune their payments by accurately estimating the expected costs of care for their beneficiaries. By helping providers identify high-risk patients who require additional care and resources, such as those with chronic conditions like diabetes or heart disease, they can develop personalized care plans that address patients’ specific health needs.
This not only helps improve their members’ health outcomes, resulting in more stable MA payouts, but also lowers the overall cost of their care. MRA calculators can also help MA plans optimize their payments, allowing them to better allocate their resources. This ultimately allows providers to provide an overall higher quality of care.
How MRA can improve patient care
While MRA calculators are good for healthcare providers, they can also help their members. These calculators can be used to identify patients who are currently underdiagnosed or undertreated, which not only improves patient health, but also helps providers provide better service, but also helps increase MA payments.
For example, if a patient has a medical problem that has not been previously diagnosed, an MRA calculator can help detect it and ensure that the patient receives the appropriate care and treatment for their needs. It also means they are able to pay for longer at a time.
Using MRA calculators, providers and MA plans can accurately estimate the expected cost of care for each beneficiary and optimize their payments accordingly. By giving providers the ability to identify high-risk and underdiagnosed or undertreated patients, these calculators can help improve provider services and resource allocation, ultimately benefiting both providers and their members.