Risk contracts can be tricky. They are generally a binding agreement between two or more parties, where one agrees to pay the other additional fees because of assumed risk.
In healthcare, risk contracts are common because of the nature of the industry. These types of contracts are necessary anytime a health plan, supplier, or insurance company is involved.
Risk contracts in healthcare are agreements where a provider agrees to pay for any additional costs and take responsibility when a certain level of risk exists in the facility.
Let’s look at this more closely.
Types Of Contracts
There are four main subjects in risk contracts that all healthcare providers need to know about. First, there are legal risks. For whatever reason, a healthcare provider doesn’t uphold their end of a contractual obligation.
Perhaps the town hasn’t got a good infrastructure and the power grid collapses quite regularly. If any aspect of a contract with a patient or provider cannot be maintained, there will be legal risks.
Next, operational risks can refer to the general day-to-day procedures. Say there is a staff member that repeatedly ignores authority and doesn’t follow the guidelines of their employment contract.
This is an operational risk because the correct structure is not being provided according to the operational guidelines.
Then there are financial risk contracts. In the case that any party cannot settle their accounts or meet financial obligations to another party, there is a monetary risk to conducting business together. The party in which the risk exists must be the one to take responsibility for any additional costs that have been incurred.
Lastly, there is compliance risk which has to do with general regulations in the healthcare space such as the Health Insurance Portability and Accountability Act (HIPAA), and the Affordable Care Act. It includes every rule, regulation, and law that a healthcare provider must follow.
Assessment Of Risk
Assessing the risk is simple, but calculating the value isn’t. Most providers use a five-point scale starting from the least likely risk to the most probable. Then there is a scale to calculate the severity of each risk and the financial liability of the provider in question.
Based on whether the healthcare provider or facility is ranked low, medium, or high risk, will determine the additional expenses to be charged should those risks become realities.
For most healthcare companies there is a fair amount of risk, all with varying degrees of severity and frequency. It can be rather challenging to calculate it effectively, so risk assessment software is available.
For anyone that works with healthcare coding and medical risk assessment, online risk adjustment software should always be used to get the most accurate results.
Risk contracts in healthcare are there to protect every party involved. Especially in healthcare, they are vital to ensure contracts are followed and compliance increases.
Accurate risk contracts can enhance the processes of the healthcare provider, ultimately giving any patient they deal with a more enjoyable experience.
These contracts also give healthcare providers an incentive to maintain contractual obligations and make sure that those risks happen as rarely as possible.
When working in an industry that takes care of people, there is always going to be some form of risk involved, but with risk contracts, these can be minimized or at least managed more effectively.