The 5 actionable risk gaps that impact revenues by $100-200 PMPY or more
Risk documentation gaps occur at multiple stages in the claim process when information is not transferred from one step to another. This occurs frequently; due to the nature of the process by which providers record information and bill payers, only a limited subset of the data captured during the visit makes it on to the claim – resulting in inaccurate risk-adjusted premium payments.
Medicare Advantage plans may be missing out on $100-200 PMPY in retrospective risk adjustment – and even larger opportunities within the current year. Our whitepaper explains how risk documentation gaps occur, how EHR data can augment claims-based HCC risk adjustment for more accurate capitation under Medicare Advantage, and how organizations can take action on that information.
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