Risk Adjustment

Our Risk Adjustment solution is designed to help healthcare organizations accurately capture and report patient risk scores. By leveraging predictive analytics and machine learning algorithms, we identify patients who are at higher risk and provide actionable insights to improve patient outcomes. Our solution includes risk stratification, coding validation, and retrospective chart reviews to ensure that healthcare providers are accurately coding and reporting patient risk scores. With our Risk Adjustment solution, healthcare organizations can optimize reimbursement and improve patient care while ensuring compliance with regulatory requirements.

Features

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Prospective & Retrospective RAF

Our solution provides risk adjustment factors for both prospective and retrospective models, enabling healthcare organizations to accurately capture and adjust for risk.

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Revenue Forecast

We offer revenue forecasting capabilities to help organizations accurately predict revenue and manage financial risk.

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Coding Gaps (Under-Coding)

Our solution identifies coding gaps or under-coding to ensure accurate and complete documentation, reducing compliance risk and increasing revenue.

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RAF Analytics (Risk Adjustment Factors)

Our RAF analytics tool provides actionable insights to help organizations optimize RAF scores and drive performance.

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Quality Gaps (Documentation Gaps)

We help identify and close documentation gaps to ensure an accurate and complete capture of all patient diagnoses, which is critical for accurate risk adjustment and revenue management.

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Compliance Monitoring

Our solution includes robust compliance monitoring capabilities to ensure adherence to regulatory requirements and prevent penalties.

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Customizable Configuration

Our solution is highly customizable and can be configured to meet the unique needs of each organization.

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Advanced Reporting

We provide advanced reporting capabilities to track and monitor performance, identify trends, and drive continuous improvement.

Use Cases

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Improving Risk Adjustment Accuracy

Are you struggling to accurately identify and assess the risk of your patient population, resulting in revenue loss for your healthcare organization?

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case study

Optimizing HCC Coding for Risk Adjustment

Are you facing challenges in identifying and coding hierarchical condition categories (HCCs) accurately, leading to inaccurate risk adjustment scores and potential payment discrepancies for your healthcare organization?

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