OVERVIEW

Integrated solutions to reduce pain points and improve risk score accuracy

Solid retrospective programs require more than good coding or intermittent review. We bring strategic vision, innovative platforms, and industry expertise for an end-to-end retrospective Risk Adjustment program – and unbundled solutions – to meet your plan’s needs
 

Our chart retrieval, gap and chase, multi-level coding review, submissions and dynamic reporting and analytics capabilities work together to close gaps, account for population health in risk scores and comply with CMS requirements

OFFERINGS

Flexible technology and service options

Balancing the components required for great Risk Adjustment is no easy task. We deliver the building blocks of Risk Adjustment with an eye to integrating data, processes and reporting for a powerhouse approach. You get tailored solutions that can stand alone or partner together

Clipboard-line-black.svg
Platform & Service
Analytics and Reporting

Powered by Machine Learning

Platform & Service

Clipboard-line-green.svg
Analytics and Reporting

Powered by machine learning

FEATURES

Robust Gap and Chase platform to capture the true illness burden of your population and assure accurate Risk Adjustment reimbursement

Streamline the retrieval of missing clinical information needed to verify chronic conditions

User-friendly interface offers self-service access and integrates seamlessly with existing systems

Centralized data storage and retrieval 

Analytics and reporting to understand trends and improve financial and program performance

Data is refreshed frequently to allow for adjustments to your coding strategy

flowchart-black.svg
Service
Chart Retrieval

Integrated retrieval methods

Service

flowchart-green.svg
Chart Retrieval

Flexible retrieval options

FEATURES

Integrates with existing workflows

Various collection methods, including fax, mail, remote EMR, and onsite collection

Online portal to monitor retrieval rates and provider issues

Retrieve some or all records

Easily navigate issues with Consolidated Clinical Data Architecture (CCDA) files, such as missing National Provider Identifier (NPI) from claims data or unmatched dates of service

Risk adjustment coding.svg
Service
Review and Coding

Accurate and complete coding

Service

Risk adjustment coding-green.svg
Review and Coding

Technology platform and service options for retrospective coding and review

FEATURES

Integrated Natural Language Processing offering both first and second pass

Certified AHIMA and AAPC-certified medical coders provide quality assurance

Web-based review and coding application

Compliance review of identified codes

Integrated reporting and analytics

gear-black.svg
Platform & Service
Submissions

Automated and configurable submissions

Platform & Service

gear-green.svg
Submissions

95-98% acceptance rate

FEATURES

Meet CMS submission requirements with compliant, validated data

UI error correction capabilities

Streamline and simplify EDPS submissions

Error-edit capabilities to correct and recycle submissions

Submission, claims matching, and add/delete processing

Support submission requirements under other national guidelines

circuit-plus-minus-black.svg
Service
Risk Mitigation and Audit Support

Comprehensive approach to compliance

Service

circuit-plus-minus-green.svg
Risk Mitigation and Audit Support

Initiatives with built-in quality assurance and comprehensive expert support

FEATURES

Certified AHIMA and AAPC coding team specializing in Risk Mitigation and RADV Audits

Comprehensive data analysis with identification of problem areas

Assist with preparing for and navigating a RADV/HRADV audit by gathering the documents required by either HHS or CMS

Prioritize retrieval activities for medical record data and perform advanced and credentialed audit record review of the data to support the HCC

Identification of the best medical data and tailored approach for submitting structured data to the Initial Validation Auditor (IVA)

Post-RADV/HRADV audit support, as needed

headphone-black.svg
Service
Consulting

Identify areas for improvement

Service

headphone-green.svg
Consulting

We combine data analysis, medical record audits and exploratory meetings to dive deep into your current program operation and process to uncover gaps in performance and make recommendations for improvement

FEATURES

Have a new strategy in place in as little as 6 weeks with an engaging work plan

Identify how and where to incorporate technology to support the coding process, allowing medical coders more time to audit charts and follow up with clinical staff as necessary

Discover the potential in data mining to identify high volume Risk Adjustment codes for auditing

Seize new opportunities to build robust documentations and coding workflows

Receive expert guidance along with a tactical implementation roadmap

Delve deeper by adding council structure and a governance framework

BENEFITS

All your retrospective problems solved in one place

S-arrow-light-green.svg

Flexible options to leverage our services or deploy technology platforms

Managed hosting

Integrate data from multiple sources and formats with a unified data exchange platform

automate-and-optimize.svg

Two third-party audits per year

Risk adjustment coding-light-green.svg

Accelerated and improved diagnostic code identification and documentation accuracy

High medical record retrieval rates help make the most of retrospective initiatives. Advanced AI-assisted technology, coupled with multi-certified medical coders, identify gaps and create a powerful system

95-98%

Quality Index for Coding and Audits

3:1-5:1

Average ROI

100%

Review of all Identified Codes

Let’s unburden your health plan today

Reach out to discover how our innovative solutions can help unburden your plan and streamline operations. Together, we’ll elevate your business to new heights

CONTACT US
mid-page-banner-one.png

SOLUTION GROUPS

Featured Risk Adjustment solutions 

icon

Prospective Risk Adjustment Solutions

Build a complete prospective Risk Adjustment program or a targeted approach with options for provider engagement, encounter processing, certified coding, and reporting and analytics. Put actionable data into the hands of providers at the point of care to close Risk Adjustment and Stars gaps