Risk adjustment accuracy and quality performance
Risk adjustment fails in one of two directions — conditions present but never documented, or conditions coded without support in the record. We work all three stages so neither happens, and the same evidence supports your quality reporting.
Risk Adjustment
- Previsit planning
- Concurrent review
- Retrospective reviews and audits
- HCC capture and validation
- RAF accuracy review
- Suspect condition identification
Quality & HEDIS
- HEDIS quality review
- Quality measure reporting
- Care gap closure programs
- AWV, CCM and RPM support
- MIPS and quality performance
- Population health analytics
Network Support
- Provider education programs
- Documentation improvement for network providers
- Coding education by specialty
- Chart retrieval and abstraction support
- Audit readiness review
- Reporting to plan, IPA, ACO and practice leadership
How the three stages work
01
Previsit Planning
Chart review ahead of the encounter to surface suspected and chronic conditions for provider confirmation.
02
Concurrent Review
Documentation support while the encounter is still open, when it can still be corrected.
03
Retrospective Reviews and Audits
Post encounter review and validation of submitted diagnoses against the record, including supplemental file build for HEDIS and risk adjustment submissions to Medicare Advantage plans.
04
Quality Alongside Risk
The same chart review supports HEDIS abstraction and care gap identification within the measurement year.