The Benefits

The RAP Certification indicates an in-depth comprehension achieved by a professional of best practices, processes and strategies for risk-based payment programs including health plans, ACA issuer, providers and ACOs.

The Risk Adjustment Practitioner Certification is appropriate for all levels of professional positions: staff, management, or leadership, practicing in the fields of:

  • data analytics
  • program management
  • revenue quality
  • revenue management
  • all levels of management
  • actuarial services
  • HCC coding / documentation
  • HEDIS and quality
  • auditing / compliance
  • other related roles

Risk Adjustment Practioner Certification indicates a level of mastery in the following areas:

  • The History of Risk Adjustment
  • The Policy Goals for the Medicare Advantage and HHS Marketplace risk adjustment programs
  • The methods used in creating risk adjustment factor scores that drive financial calibration of payment rates
  • The Operations implications - the workflow sequencing and dependencies that link to payment streams, annual work and program cycles, and payer / provider interactions
  • The complications of Multi-program interactions – the linkages between risk adjustment programs and activities with those of Stars / Quality / HEDIS
  • The Provider relations and provider education elements critical for effective program management
  • The Mitigation strategies utilized for Compliance and Risk insuring security
  • The Connection between coding and chart documentation at the provider level and the RADV program
  • The overall approach for Risk adjustment program management, utilizing best practices to manage risk adjustment and revenue at the payer and provider levels
While much of this program concentrates on a health plan or ACA issuer perspective, it is also critical for provider purposes, including risk-based contracts with health plans and ACOs. Without the full contextual perspective, provider organizations cannot fully appreciate their critical roles in the process, nor adequately plan and implement internal actions to improve their situation in risk-based payment programs.
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