News & Information

The Purpose of Risk Adjustment

Risk adjustment allows CMS to pay plans for the risk of the beneficiaries they enroll. By risk adjusting plan
payments, CMS is able to make appropriate and accurate payments for enrollees with differences in expected costs. Increased accuracy benefits patients, providers, health plans, and the nation as a whole.
 
Introduction to Risk Adjustment Guide 101

About this Training

This Risk Adjustment training is organized into six modules:

  1. Overview - Defines risk adjustment and its purpose while also providing essential terminology and acronyms.
  2. Connectivity and Testing - Discusses the process for connecting to and testing the Risk Adjustment Processing System.
  3. Key Data Elements - Provides an overview of the types of data required for risk adjustment, as well as acceptable sources for data collection.
  4. The Risk Adjustment Processing System (RAPS) - Introduces the Risk Adjustment Processing System (RAPS), the format and flow for submitting risk adjustment data, and the timeline for RAPS submissions.
  5. Reports - Presents the Front-EndRisk Adjustment System (FERAS) and the CMS RAPS data logic and editing processes while describing FERAS and RAPS reports used by plans for risk adjustment.
  6. Resources - Provides access to key resources and important links to ensure a foundation for understanding risk adjustment.
 
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