Comprehensive Risk Adjustment, Coding, and Compliance Services

Our Services In Detail:


Prospective Chart Review:

Review of assigned member’s documentation in “real-time” for active and supported clinical conditions. We extract all CMS and RX HCCs for submission to your Organization. We identify deficiencies in the Provider’s documentation that prevents ICD-9 code assignment and generate suspect conditions for Physician follow-up and validation.

Retrospective Chart Review:

This review is customized and developed for your Organization after a comprehensive analysis of your data files. Retrospective Review incorporates your Primary Care Physicians and identified Specialist for chart review of the previous treatment year documentation to current for all CMS and RX HCCs for submission. Educational opportunities are identified at the Primary Physician level only.

Provider Education for Risk Adjustment:

Educational sessions are offered in a group setting or one-on-one with your Physician(s). We customize and provide training to meet your Organization’s current needs. We can discuss the basics of Risk Adjustment such as the different models within Risk Adjustment, what is EDPS and RAPS, risk scores, how to identify erroneous data and create a delete process for your Organization to be compliant. We discuss the importance of following documentation guidelines, the importance of providing comprehensive care to yours patients, and how to reflect the care provided to meet Risk Adjustment guidelines. Your documentation is the “key” to your success. We identify common clinical conditions within the geriatric population of patients that are within the Risk Adjustment model as well as recommendations for annual diagnostic testing. We discuss concerns often found during chart review that impact your performance and how to prevent those errors when providing your day-to-day patient care.

Utilization Management:

We assist with tracking inpatient admission course, communicate findings back to the patient’s Primary Care Physician (PCP), and work with your team to assist and secure a safe discharge and follow up appointment with the PCP.

Consultation:

We can evaluate your current Risk Adjustment process and identify areas that may be impacting your performance and offer recommendations and ideas for improvement. We partner with your Organization as “your sole resource” and “team” to help navigate the various components of healthcare and develop an internal program or act as an “extension” of your current team to assist with management of your volume and or completion of special projects to support your Company in meeting yearly goals.