Risk Adjustment
We are expertise in different types of risk adjustment models that are used to risk-adjust healthcare data such as HCC, HHS, CDPS, FCC etc…
Risk adjustment is a statistical process that considers the underlying health status and health spending of patients when examining their healthcare outcomes or healthcare costs. There are several types of risk adjustment models that are used to risk-adjust healthcare data such as HCC, HHS, CDPS, etc…
For Medicare Advantage, ACA, and Medicaid plans, accurate risk adjustment plays a critical role in the overall success of a health plan. Without a risk score that reflects actual member diagnoses, you will most likely miss out on reimbursements and may not be providing the best patient care that you can.
Service Overview
We offer a full-service HCC coding solution for all risk adjustment coding: ACA-Commercial, Medicare Advantage, and Managed Medicaid. Our compliance-based approach to medical record coding is delivered by AAPC or AHIMA certified coders who capture or suggest deletion of risk adjusting diagnostic codes and can also perform data validation audits.
1GENRCM provides comprehensive, end-to-end prospective and retrospective risk adjustment services. We have deep subject-matter expertise to ensure risk-associated revenue is optimized while maintaining appropriate compliance. We provide full transparency at every stage, so you always know the status of your risk adjustment program.
Our team has hands on experience working on different types of Tools/Applications:
Services in Risk Adjustment Space;
1) Front-end analytics services for suspecting of patient conditions
2) Prospective risk adjustment reviews
3) Retrospective risk adjustment reviews
4) Concurrent risk adjustment guidance
5) Risk adjustment educational programs (CMS-HCC, HHS-HCC, commercial exchange and Medicaid managed care)
6) Risk adjustment data validation (RADV)
7) NLP risk adjustment coding audit