Keys to Maximize Revenue During the RAPS/EDS Transition

Prevent catastrophic losses by acting now

CMS’ recent Final Call Letter detailed the incremental migration plan from the current Risk Adjustment Payment System (RAPS) to the Encounter Data Processing System (EDS) over the course of the next four years. The intent of the gradual transition is to ease health plans through the revenue changes as a result of the shift – and to mitigate potentially radical losses in revenue.
Based on the findings of a recent Altegra Health study, even with the initial 90/10 percent split, health plans are likely to lose millions in revenue:
Health Plan Revenue Score Range 90% RAPS 10% EDS PY2016
Low End -0.2%
High End -2.5%
Average Revenue Decrease -1.2%


In order to minimize the negative impact of the transition, health plans must begin conducting complete and accurate analyses of their member population risk now– thus ensuring the maximum CMS payment. But where do you begin? Let Altegra Health become an extension of your plan, partnering with you as a guide, strategist and support team, providing proven solutions for minimizing risk score gaps and errors, and maximizing payments. RISK View™, our advanced risk adjustment software program, offers features specifically for risk score improvement:
  • Member-level comparison New! – Get access to member-level RAPS/EDS side-by-side comparison and blended scores, helping you gain insight into each member’s risk score impact.
  • Aggregate data – At the other end of the analysis spectrum is the aggregate data feature, giving you a big-picture view for your member population risk. This, coupled with the new member-level-comparison feature, allows you to see risk impact as never before.
  • Contract-level and health plan-level impact analytics New! – These additional levels of analytical information can be used to further help you reach your financial goals.
  • Risk score variance analytics New! – This feature evaluates CMS scoring logic and presents expected risk scores verses accepted risk scores to help ensure appropriate risk adjustment for your members.
Altegra Health offers you the keys to maximizing your revenue throughout the RAPS/EDS transition by the way of greater visibility into your member population risk and expected financial payments. Additionally, you can leverage potential risk value insights through Encounter Complete’s™ error identification and prioritization capabilities. As integrated products, RISK View and Encounter Complete equip you with the ability to efficiently and effectively manage your risk like never before.

Next Steps

Start protecting your 2016 revenue today! Call 1-877-461-0415 or email us.