Payer Solutions Drive Risk Adjustment Improvement

Our payer solutions allow both government payers and risk-bearing providers to improve their risk adjustment and quality initiatives. Using a single enterprise platform, we deliver intuitive, comprehensive solutions that improve productivity, increase accuracy, and provide real-time analytic reporting and control.

Improve Risk Adjustment With the Right Technology and Resources

Our proprietary technology-enabled platform provides flexibility to choose the services you need to be successful. The GeBBS risk assessment dashboard illustrates the impact of different diagnoses on the total Risk Adjustment Factor (RAF) score in real-time and includes recommendations for improvement. We provide some of the highest results around risk adjustment coding, HEDIS abstraction, and retrieval.

2000+

Coders for any scale of projects

Proprietary Technology Optimizes Risk Adjustment

Our Chart Acquisition platform is data-driven to reduce overall acquisition cost. Our acquisition call center resources are white-labeled and easily customized, allowing clients flexibility for their business needs. The client-centered platform is highly secure and provides an integrated solution where the payer can drive priorities, timing, approach, and track performance across multiple retrieval needs. Using our platform, healthcare organizations can receive charts directly from providers – quickly, automatically, and cost-effectively.

technologies

Enterprise coding solution
  • 40%

use of provider portal in upload
  • 30%

reduction in chart retrieval costs

Easy to use provider portal reduces provider abrasion

Chart data searchable by provider, member, disease category/diagnosis and keywords to prioritize actions from retrieval through chart review

Multiple modality retrieval options to increase the likelihood of success with providers

Single performance management dashboard for real-time insight on project status, non-participating management and payment processing

Improving HEDIS scores is a priority for almost every payer and health plan in the US. HEDIS compliance can be intimidating and often challenging for payers. Our integrated HEDIS abstraction solutions provide both real-time and retrospective data that help payers improve care delivery, quality, and member satisfaction. The GeBBS web-based data management platform provides unprecedented transparency while maintaining cost-effectiveness. It also has built-in workflows for external overreads and Medical Record Review Validation (MRRV) audits.
technologies

Enterprise coding solution
  • 95%

Record retrieval for abstraction
  • 98%

Abstraction quality

Identify gaps to improve quality through searchable chart repository

Produce real-time compliance reporting by measure

Perform risk adjustment and monitor quality simultaneously

IMPACT

20%

Increase in reimbursements based on new RAF calculations for clients

GeBBS’ risk adjustment payer analytics are backed by powerful technology-driven processing that integrates Natural Language Processing (NLP) solutions, robust data validation, and QA initiatives. This workflow empowers efficiency with real-time targeted diagnoses and actionable datasets. Our completely customizable solutions can be tailored for second and third-level reviews, blinded coding, claims data validation, and QA scrutiny.

technologies

Enterprise coding solution
  • 98%

data captured on 1st pass

  • 25%

additional cost RA Codes added

Layered solutions to ensure completeness and accuracy of coding data

Complete client transparency with access to all data and analytics

Reports captured which provide analytical insights on revenue variance and error trending

Hierarchical condition categories (HCC) predict the healthcare spending for patients and for developing each Medicare beneficiary’s Risk Adjustment Factor (RAF). GeBBS enables you to document HCC patient treatment accurately — arriving at precise RAF calculations through accurate HCC coding and smart documentation management.Our compliance-based approach to medical record coding is delivered by coders certified by AAPC or AHIMA. They capture or suggest deletion of risk adjusting diagnostic codes and perform data validation audits with actionable reports. We offer a full-service HCC coding solution: ACA-Commercial, Medicare Advantage, and Managed Medicaid.
technologies

Enterprise coding solution
  • 0.75%

Average increase in RAF scores
  • 20%

Increase in reimbursements based on new RAF calculations for clients

Highest standards of coding quality with ongoing quality checks occurring throughout the life cycle of projects

Real-time RAF reporting to help payers extract appropriate compensation and avoid sizable penalties

Confirmed accuracy of existing diagnosis data and identification of risk-adjusted conditions that were not previously submitted

A web-based interactive client portal for real-time transparency into project progress and the ability to view operational data at each stage of the project

Continuing provider education and training can significantly impact your revenue cycle by minimizing errors and staying on top of compliance and audits. Our provider education platform gives a comprehensive view to identify opportunities for provider education and feedback. It also allows you to review trending reports and education by provider, specialty, or HCC category. Our customizable education dashboard helps you and providers benchmark performance against other healthcare plans, groups, and peers. Moreover, our coders help identify processes and conditions that do not meet CMS criteria based on documentation.

technologies

Enterprise coding solution
  • 0.75%

 Average increase in RAF scores

  • 18%

 Increased HCC identified in Level 2 review

Real-time pre-bill provider query for live training and education on actual medical chart review

Retrospective reviews leveraging the end-to-end integrated platform

Better coding to improved cash flow for risk-bearing providers

Improved documentation at point-of-care reducing payer review costs

Risk adjustment factor (RAF) scores help to get accurate provider diagnosis documentation. RAF scores are calculated by applying the HCC model to a beneficiary, taking into consideration their health condition, symptoms, and demographics. GeBBS’ RAF score reporting dashboard gives you a consolidated view of your plan, group, or individual member’s score. You can also see, in real-time, how the addition or deletion of different diagnoses affects the RAF score. In addition, we also provide suggestions on documentation and provider education to improve a particular RAF score.

technologies

Enterprise coding solution
  • 0.75

Average increase in RAF score

  • 20%

Increase in reimbursements based on new RAF calculations for clients

Artificial Intelligence and Cognitive Analytics Engine (iCAE) to improve the RAF score

Real-time dashboard for insights on RAF score for better decision-making and executive reporting

Concurrent and retrospective chart review options to improve RAF scores and documentation

Improved code capture for better RAF score accuracy for achieving ROI

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Impact Delivered by Risk Adjustment HCC Coding Solutions

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