Medicare Risk Adjustment Tip: Templates
Guidelines provided by WPS and Medicare enable the use of documentation templates as long as they are individualized for each patient’s needs and experiences.
Explaining the RAPS vs EDPS
When it comes to healthcare and medical coding, two terms that often come up are RAPS and EDPS. These acronyms refer to two different systems used in the Medicare Advantage (MA) and Prescription Drug (Part D) programs. Let's explore what RAPS and EDPS mean and how they differ: RAPS (Risk Adjustment Processing System): RAPS stands for Risk Adjustment Processing System. It is a system used by Medicare Advantage plans to submit diagnosis data for their enrolled members. The purpose of RAPS is to determine the risk profile of each Medicare beneficiary based on their health conditions. This risk score calculation helps determine the payment amount that Medicare Advantage plans receive for each member. RAPS relies on diagnoses reported by healthcare providers on claims submissions. EDPS (Encounter Data Processing System): EDPS stands for Encounter Data Processing System. It is another system used by Medicare Advantage plans, but in this case, it focuses on the submission of encounter dat
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