Providers are the source for care, quality, compliance, and risk adjustment documentation. Our solutions assist physician groups, Accountable Care Organizations (ACO), Independent Physician Associations (IPA), and Management Services Organizations (MSO) in improving their clinical coding accuracy and specificity. Our services enhance each provider’s ability to perform data aggregation, as well as manage their quality and risk adjustment strategies. Having insight into risk adjustment and the patients’ health status creates the opportunity for improvements in the quality of care for members—which has an impact on financial outcomes.
By RaeAnn Grossman What does your risk adjustment team need to think about from application time to bid season? Answers include but are not limited to: Are we changing our formulary and will this impact Rx risk adjustment? Are we narrowing our provider networks and will this impact campaigns or waves? Are we capitating more […]
By RaeAnn Grossman First, have you integrated compliance and risk adjustment? Have you embedded your risk mitigation strategies? Here are a few items that should be on your compliance for risk adjustment checklist: Review coding guidelines quarterly (internally and with vendors) Perform 2LR and 3LR annually Embed claims validation into Medicare Advantage, Commercial, and Medicaid […]