Medical Risk Adjustment

Health care providers are undergoing a massive shift in how health care is delivered—and how it’s paid for. It’s a move from fee-for-service, or volume care—where the more you do, the more you get paid—to value-based care—where physicians are rewarded for providing high-quality, efficient care. Many factors drive success in value-based care, but one of the most crucial is Medical Risk Adjustment. 

Medical Risk Adjustment (MRA) Education Module

MRA helps health insurance payers – including Medicare – understand how sick your patients really are, as indicated by their risk scores.  MRA is used in value-based models to ensure that cost targets are adjusted to align with the illness burden of the population. The NHN has created a quick 15 minute video to help you understand how MRA works and what you can do to insure you are not penalized for taking care of sicker patients.

Medical Risk Adjustment Education Module


The Basics of Medical Risk Adjustment

The NHN has a developed a quick, one-page document to help you or your fellow providers and coders understand WHAT MRA is, WHY it is important, HOW to optimize risk capture, and a quick example on how MRA WORKS.

Medical Risk Adjustment One-Page Explainer

Hierarchical Condition Category (HCC) Coding

COMING SOON! The NHN is currently developing a Quick Reference Guide to assist you with your everyday coding needs.

HCC Quick Reference Guide

  • COMING SOON! (please contact us if you are interested in piloting HCC Quick Reference Guides)