Technology-based Risk Adjustment: An Advantageous Process for Providers and Payers
Streamlining workflow and improving quality for government payers and risk-bearing providers of all sizes I. IntroductionThe definition of risk is the possibility of loss or injury, or โthe chance of…
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…
Risk Adjustment โ 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…