Risk Adjustment
Professional advisory opinions and audit support.
We advocate for the purpose of risk adjustment in proactively managing disease for all patients, aiming to enhance health outcomes. Our services are tailored to safeguard the integrity of your risk adjustment initiatives.
Risk adjustment is a method used to estimate the cost of treating patients based on their specific health needs, ensuring fair compensation for healthcare providers. It enables providers to address the diverse healthcare needs of patients and ensures equitable payments. The CMS Innovation Center utilizes risk adjustment to set financial targets in its models, ensuring accurate payments to participating providers. Additionally, risk adjustment helps calculate prepayment for patient care and is continually reviewed and improved to reflect patients’ evolving health statuses.
We offer comprehensive advisory opinions and audit support to safeguard your risk adjustment programs, including:
– Review of best coding practices
– Evaluation of policies and procedures
– Coding audits, whether conducted internally or by a third party
– Assistance in resolving coding disputes
– Support during legal audits, including those conducted by the Department of Justice (DOJ) and the Office of Inspector General (OIG)
Medical Record Retrieval Services to healthcare Providers, Payers, and Law Firms nationwide.
Medical record collection is paramount.
As an essential component of documentation reviews and legal proceedings.
Over a decade of successful experience. We employ compliant and verifiable methods, including digital extraction and physical retrievals.
Ensure fair and accurate payments for healthcare providers in CMS Innovation Center models.
Contact us to optimize your risk adjustment strategies and maximize your financial targets.