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Medicare Risk Adjustment

We take a prospective approach to risk adjustment, going beyond the typical strategy of providing retrospective reviews and claims data analysis. We identify opportunities for efficiency and performance improvement in coding patterns, data integrity, and diagnosis volumes and trends. Our consultants help clients refine processes and systems to capture timely, complete, and accurate claims data. Our team of expert physicians and nurse consultants train client staff and providers about documentation and diagnosis coding, analyze client data collection and submission processes, and deliver meaningful analytics for understanding reimbursement complexities.

Long-term optimization of risk adjustment outcomes is complex and for many organizations, significantly affects financial performance. We specialize in helping clients optimize processes and systems to capture timely, complete, and accurate data. Through these services, we currently help PACE and other healthcare organizations remain compliant with regulations, make reliable comparisons to internal and external benchmarks, and identify high-volume/high-cost issues for quality program initiatives.