Risk Adjustment, HHS-HCC Model, and RADV Audits on the Exchanges

Tim Buxton, Director of Coding Services

In early 2014, DHHS introduced the concepts of Risk Adjustment for the Health Insurance Exchanges. Despite the intervening months, there remains a large amount of confusion and some lingering questions regarding the details of the program.

This webinar will review:

  • Purpose & Overview of Commercial Risk Adjustment on the Health Insurance Exchanges (HIX)
  • HHS-HCC Model vs. CMS-HCC Model
  • Commercial RADV Process, & What HHS Says
  • Concerns and Expectations HIX RADV
  • Preparing for the HIX RADV Process

Presentation @ RISE VBC: Effective Collaboration Strategies Between Payer & Provider