Risk adjustment and CDI: A natural evolution

Healthcare reimbursement is changing; both CMS and private payers are working toward payment methodologies that reflect quality of care versus quantity of care. In most cases, quality is measured based on patient outcomes. The concept of risk adjustment is now being applied to healthcare reimbursement  and used for quality monitors such as 30-day mortality measures, 30-day readmissions, and Medicare spending per beneficiary. Healthcare organizations must be aware of how documentation supports risk adjustment and take efforts to educate providers on the importance of complete and thorough capture of their patients’ health status to support accurate code assignment representing the potential risk their patients possess.