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 develo...