Risk Adjustment

Why GeBBS?

  • U.S.-based company
  • Multiple global delivery centers in three countries
    • U.S
    • India
    • Manila
  • U.S.-based oversight and implementations

Look no further than GeBBs for all your risk adjustment needs. The risk adjustment model enacted under the Affordable Care Act (ACA) is designed to be budget neutral. Total payments to risk providers in the risk adjustment model do not increase; rather, insurers who cover greater numbers of healthy individuals contribute to a risk adjustment pool that is used to fund higher reimbursements to insurers who cover a larger proportion of high-risk individuals. The Hierarchical Condition Category (HCC) is the risk adjustment model used by Medicare and Medicaid to calculate risk scores. The HCC ranks diagnoses into categories of conditions based on similar cost patterns. The HCC depends on patient data being reported completely and accurately. Reporting requirements for healthcare providers include identifying chronic and severe conditions for each patient and substantiating a base year health profile for these patients. Information within the medical record must support the diagnoses and indicate a management plan. Collection and review of this information must occur once each calendar year and is used to predict costs for the following year. Thus, accurate coding and thorough chart review and chart retrieval have a direct effect on patient outcomes and reimbursements.

GeBBS provides a rightshore Payer BPO model for population health, risk adjustment, revenue management, and clinical review. Thorough and careful Medicare and Medicaid risk adjustments are critical to accurately capturing the health status of the beneficiaries, so resources can be appropriately allocated to treat and manage care. GeBBS is committed to collecting every relevant medical record, coding each one correctly and delivering reliable, accurate results for use in risk adjustments. We are a U.S.-based company with multiple global delivery in three countries. We can provide scalability, increase quality, and reduce costs with all oversight and implementations done in the U.S. Partner with GeBBS for all your Medicare and Medicaid risk adjustment needs.

Payer Solutions

GeBBS offers a number of solutions including:

Risk Adjustment

  • Medical record review
  • Secondary audits & overread
  • Provider education & support

Quality and Compliance

  • HEDIS
  • Medical record abstraction
  • Telephonic outreach & scheduling
  • STARS
    • Member satisfaction surveys
    • MOC STARS member surveys
    • Interventions/gap closure
    • Medication reconciliation

Case and Care Management

  • Telephonic health risk assessments and surveys
  • Care coordination and scheduling (network steerage)
  • Medication reconciliation and adherence
  • Pre-Authorization management

Utilization Management

  • Concurrent review for medical appropriateness
  • Retrospective review for quality assurance
  • Prior Authorization/Pre-Certification management
  • Medical necessity/level of care review programs
  • Appeals & Grievances – data intake, administrative & tier 1 medical review

Post Utilization Solutions

  • Audit
  • DRG
  • Coding review
  • Claims management
  • Appeals management

News Release | April 21, 2017