Results for Risk Adjustment

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Blogs

How Automated HCC Validation Improves RAF Accuracy and Audit Readiness

RAF accuracy doesn’t fall apart all at once. It usually frays quietly, one unsupported diagnosis or documentation gap at a time. And if you’re responsible for risk adjustment, HCC coding, compliance, or financial performance, you know how frustrating that can be. A code looks right. The condition seems familiar. The ...Read More

Blogs

5 Ways a Risk Adjustment Coding Company Can Unlock Millions in Missed Revenue

Every year, payers leave millions on the table. Simply put, critical diagnoses just never make it from the chart to the claim. You know it’s not for lack of effort. Your team works hard and audits regularly, yet still…the numbers don’t quite add up. Maybe you’ve caught yourself staring at ...Read More

Blogs

Retrospective Risk Adjustment: The Shortcut to Capturing Every Dollar You’ve Earned

Margins are razor thin in 2025. And yet, millions still slip away quietly. The endless cycle of missed HCCs, incomplete charts, documentation gaps, and other missteps adds up fast. It feels like trying to fill a bucket with holes. No matter how much effort your team pours in, the revenue ...Read More

Blogs

Is Risk Adjustment Coding a Constant Struggle? What Top Teams Do Differently

Risk adjustment coding can be a pressure cooker. Every chart feels like a guessing game. One minute you're scanning EHRs for clues, the next you're chasing down a provider to clarify a cryptic note from six weeks ago. Meanwhile, the deadline looms, and you’re still unsure whether the RAF score ...Read More

News

GeBBS Healthcare Acquires CPa Medical Billing

Acquiring CPa Medical Billing expands GeBBS’ end-to-end RCM solution offering to FQHC market.GeBBS Healthcare Solutions, Inc., (ChrysCapital portfolio company), a leading provider of Revenue Cycle Management (RCM) and Risk Adjustment Solutions for Healthcare Providers and Payers, announced today the acquisition of CPa Medical Billing an East Haven, CT-based provider of Revenue Cycle ...Read More

Case Studies

Second Level Review Gives You The Peace of Mind That You Are Ready for RADVs

GeBBS Healthcare Solutions applies insights to encounter details that lead to appropriate risk scores and ensures compliance. Patients are complex. This is especially true when they are Medicare Advantage enrollees. These older adults typically enter the healthcare system with a specific complaint, requesting treatment for that one issue. Their path ...Read More

Webinars

BCG – Financial Impact of Revenue Cycle Outsourcing in a Post Pandemic World

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Webinars

McDermott Will & Emery, McDermott+Consulting – Telehealth Compliance: Implications on Billing, Coding, & Reimbursement

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Whitepapers

Removing Redundancies from Healthcare RCM with Robotic Process Automation

The creation and development of robotic process automation (RPA) has had a tremendous impact on various industries over the last few years. While companies in all sectors have benefited from this technology, RPA has been particularly useful for healthcare revenue cycle management (RCM).Healthcare organizations like hospitals, physicians’ groups, and other ...Read More

Whitepapers

Mitigate Compliance Risk & Enhance Revenue Integrity

One Platform for All Compliance & Auditing Requirements I. Coding Audits: The Cornerstone of Compliance & Revenue IntegrityAccording to the Healthcare Financial Management Association (HFMA), lowering compliance risk and ensuring the accuracy of charges should be top concerns of revenue integrity programs.4 Administrative costs, which are frequently cited as a ...Read More

Whitepapers

The Compliance and Credit Balance Conundrum

"HFMA calls credit balances the “stealth aircraft of hospital patient accounting.” I. Credit Balances Are Not Always What They SeemCredit is a word we hear almost daily, and many people are already familiar with the fact that accounting uses credits and debits to ‘balance the books.’ In the everyday vernacular, ...Read More

Case Studies

Risk Adjustment – Second Level Review: HHS-HCC score increased from 3.89 to 4.4 across ACA members

Client Background and Context National Health Plan with 3.5M+ members. The Fortune 500 client found gaps in their coding & claims data collection/submission process for a subset of their ACA population. The client wanted to ensure accurate & complete code capture with compliance and quality. Solution 2nd level review through ...Read More

Case Studies

Internal Data & Audit Platform: 30% increase in productivity & 50% reduction in technology spend

Client Background and Context Client with 20+ risk-bearing locations & various data input sources wanted to: Partner with a platform to audit codes received from multiple sourcesImprove productivity of each of their locations & divisionsIncrease data quality of codes added by internal & external partnersEnhance operating margins through cost optimization Solution ...Read More

Case Studies

Risk Adjustment – Second Level Review: 20% more risk factors added across 1M+ Medicare Advantage members

Client Background and Context National Health Plan with 6M+ members of which 1M+ MA. The client found gaps in their coding & claims data collection/submission process. The client wanted to: Overcome issues in collecting the correct data and documentationFix the incomplete HCC risk scoreEnsure correct addition/deletion data is sent to CMSMitigate ...Read More

Infographics

GeBBS’ end-to-end Enterprise Solution for Risk Adjustment and Quality Initiatives

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Blogs

Are You RADV Audit Ready? Three Strategies to Get You There

The Centers for Medicare and Medicaid Services (CMS) recently announced plans to ramp up its risk adjustment data validation (RADV) audit program in 2020 based on a recent study by the Office of Inspector General (OIG), which found potential issues related to Medicare Advantage Organizations (MAOs) using chart reviews to ...Read More

Blogs

Rev Up Your Revenue Cycle with AI

With profit margins shrinking and the cost of health care going nowhere but up, operational leaders and consultants throughout the healthcare industry are looking in every nook and cranny to either find ways to cut costs or generate more revenue. With the ongoing need for costly equipment, an expert workforce ...Read More

Blogs

NLP Healthcare – Risk Adjustment Meets Artificial Intelligence

Big data is all the rage – transforming industries from tech to retail and much more. Healthcare – an industry slow to adopt technology in many ways now has access to more data than ever before with the widespread adoption of electronic health records (EHRs). But, what do we do ...Read More

Blogs

It’s Working – CMS Report Concludes the Effectiveness of Risk Adjustment

In late June, the Centers for Medicare & Medicaid Services released data demonstrating that its Risk Adjustment Program – developed as part of the Affordable Care Act just five years ago – is working just as planned. What was the plan? To prevent payers from developing plans intended to attract ...Read More

Blogs

Strategies for Mastering Two-Sided Risk

Population health and the transition to two-sided risk is no easy feat – it’s a monumental shift in the way providers, payers and hospitals think about the delivery of health care. And, while, we all know it’s coming – knowing how to get there and doing it successfully is the ...Read More

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