RAPS vs EDPS: Which Risk Adjustment System is Right for You?

 

In the United States, Medicare uses risk adjustment to determine how much money to reimburse health plans for each beneficiary. Risk adjustment is a way of adjusting payments to health plans to account for the different health risks of their beneficiaries.

There are two main risk adjustment systems used in Medicare: RAPS and EDPS. RAPS stands for Risk Adjustment Processing System, and EDPS stands for Encounter Data Processing System.

RAPS

RAPS is the older of the two systems. It was developed in the early 2000s, and it uses a variety of data sources to assess beneficiary health risk. These data sources include demographic information, claims data, and laboratory data.

RAPS is a relatively simple system, but it has some limitations. For example, it does not take into account all of the factors that can affect beneficiary health risk. Additionally, RAPS can be slow to update, which can lead to inaccurate payments.

EDPS

EDPS is the newer of the two systems. It was developed in the mid-2010s, and it uses encounter data to assess beneficiary health risk. Encounter data is information about the services that beneficiaries receive from healthcare providers.

EDPS is a more comprehensive system than RAPS, and it is more accurate. However, EDPS is also more complex and expensive to administer.

Which System is Right for You?

The best risk adjustment system for you will depend on your specific needs. If you are looking for a simple and affordable system, then RAPS may be a good option. However, if you are looking for a more comprehensive and accurate system, then EDPS may be a better choice.

Access Health Care Physicians

Access Health Care Physicians is a Medicare Advantage health plan that offers both RAPS and EDPS risk adjustment. We can help you choose the right system for your needs, and we can provide you with the support you need to manage your risk adjustment payments.

Contact Us

To learn more about RAPS vs EDPS, or to get started with Access Health Care Physicians, please contact us today. We would be happy to answer any of your questions and help you find the right solution for your needs.

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