We specialize in surfacing opportunities for better risk adjustment program performance. And we’re committed to ensuring you receive equitable compensation for the health conditions, health status, and demographics of your beneficiaries.
Prospective Risk Adjustment Chart Auditing
Our certified auditors and medical coders will identify gaps in care, assessment, and clinical documentation. And we equip your physicians for optimal patient monitoring and point-of care decisions, informed of chronic conditions, and suspected HCCs.
Retrospective Risk Adjustment Chart Auditing
Raise your risk-adjusted revenue and reduce your CMS RADV audit risk with our flexible services, ranging from focused audits for target populations and specific HCCs to end-of-year sweeps. Our experienced teams review patient encounter data in clinical documentation to identify diagnoses and conditions missing from original claims.
Concurrent Risk Adjustment Chart Auditing
Trim the intensity, cost, and error potential of annual sweeps by ensuring HCCs are captured correctly on encounter claims. Our RA team reviews for under-documented risk opportunities and verifies that all codes and conditions are accurate and supported by proper documentation. Missed diagnosis codes are then updated within the workflow, prior to claim submission.
Trial-Run RADV Audit Services
Mitigate your Risk Adjustment Data Validation (RADV) audit risks when our risk adjustment teams outline your substantiated HCCs, unsubstantiated HCCs, and unreported HCCs and equip you with actionable items to secure your compliance and safeguard your risk-adjusted revenue.
Initial Validation Audit (IVA) Services
Our IVA teams have the data validation expertise to lead you through the IVA process. We’ll complete your risk adjustment IVA on time and in compliance with HHS's requirements for validation of member demographic and enrollment data, medical claims data, and health status data.
Provider Engagement & Risk Adjustment Education
Our Provider Engagement and Risk Adjustment Education programs bridge the gap between your health plan and your providers. While nurturing engagement and partnership, we make sure your providers have the training and support needed to implement RA best practices. And we help establish processes to tract suspects, follow through with patient outreach, and optimize documentation and coding.
Your health plan can rely on us to capture severity levels and secondary manifestations as we have extensive experience extracting diagnoses that substantiate disease and comorbid condition data. You can also count on us to perform quality assurance of all coding results to ensure your submission to CMS is accurate, optimal, and compliant.
We offer a full catalog of risk adjustment solutions, customized to meet the needs of small physician practices, a mid-size health plans, and multi-hospital health systems. Our teams specialize in risk methodologies, such as:
Medicare and Medicaid CDPS Model
HHS HCC Model
Hybrid Risk Models