Comprehensive Risk Adjustment, Coding, and Compliance Services

About Our Process:

Innovative Clinical Partners is an independent third party vendor who partners with Managed Service Organizations (MSO), Independent Practice Associations (IPA) and or Health Managed Organizations (HMO) who participate in Medicare Advantage. Although, we are located in Central Florida, our Organization works with clients throughout the United States.

Our team of Registered Nurses and Certified Coders are experienced and well versed in Risk Adjustment. We provide retrospective review of your medical records for submission as well as prospective chart analysis. Our strength lies in our expertise for communicating to the treating Physician the areas of the record where documentation fails to support a valid Risk Adjusted code. We collaborate with Physicians to expand their knowledge of Risk Adjustment, improve their documentation performance to support appropriate and specific ICD-9 code assignment, and comprehensively review records of your assigned membership to identify all applicable clinical conditions. We focus attention on conducting a comprehensive chart review of your patient population, resulting in accurate Hierarchical Condition Category (HCC) assignment allowing proper Risk Score calculation.

During our chart reviews, all documentation is evaluated for CMS and RX HCCs. We conduct reviews year round and focus our educational opportunities at the Primary Care Physician level, where Risk Adjustment “lives.” However, to provide thorough assessment of the patient’s overall health status, we incorporate Specialist records in our review to identify and record all clinical conditions treated. Our team tracks and communicates chronic clinical conditions yearly to ensure year-to-year validation.

Risk Adjustment is a clinical process with a financial outcome. The care must be given and accounted for to assign appropriate risk adjusted diagnoses that reflect accurate risk scores.