Which is Better for Your Practice: RAPS or EDPS?

When it comes to Medicare risk adjustment, there are two main methodologies that healthcare providers can choose from: RAPS and EDPS. Understanding the differences between the two can help you decide which is better for your practice.

RAPS (Risk Adjustment Processing System) is the traditional method of risk adjustment used by CMS (Centers for Medicare and Medicaid Services). With RAPS, healthcare providers submit diagnosis codes to CMS for their Medicare Advantage patients. CMS then uses these codes to calculate risk scores, which are used to determine the amount of reimbursement the healthcare provider will receive.

EDPS (Encounter Data Processing System) is a newer method of risk adjustment that was introduced by CMS in 2016. With EDPS, healthcare providers submit encounter data to CMS that includes diagnosis codes, service dates, and other information. CMS then uses this data to calculate risk scores.

Risk Adjustment | GHG Advisors 

So which method is better for your practice? It depends on your specific situation. Here are some factors to consider:

Accuracy: EDPS is generally considered to be more accurate than RAPS, since it uses actual encounter data rather than relying on diagnosis codes. However, this also means that the data needs to be complete and accurate in order for EDPS to work effectively.


Timeliness: RAPS has a shorter submission window than EDPS, which means that providers need to submit their data more quickly. However, EDPS allows for ongoing submission of data throughout the year.

Complexity: RAPS is generally considered to be less complex than EDPS, since it only requires submission of diagnosis codes. EDPS, on the other hand, requires more detailed encounter data.
Resources: Implementing EDPS may require additional resources, such as staff training or new software systems.

Ultimately, the decision between RAPS and EDPS will depend on your practice's specific needs and resources. It may be helpful to consult with a Medicare risk adjustment expert to determine which method is right for you.

Location: 14690 Spring Hill Dr, Spring Hill, FL 34609, USA

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