Clinically Enhanced Risk Adjustment

Use EHR data to improve HCC measurement and risk adjustment for Medicare, Medicaid, and commercial contracts.

  • Use automated EHR interfaces to perform thousands of chart audits in minutes.
  • Identify opportunities to more accurately document patient risk, increase reimbursements, and improve patient care.
  • Deep-mining of unstructured data powers an enhanced HCC risk algorithm.
  • Real-time risk profiling and full progress note availability.

Why claims-based approaches to risk are deficient – and what to do about it. 

The traditional approach to risk adjustment uses claims-based data, but this approach to calculating clinical risk is deficient – and it can put an organization at financial risk.  Claims-based information is incomplete, slow, misaligned with provider data, and often not relevant at the point of care.   Luckily, EHR data can close the gaps.

Read our blog post.

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.

Get the whitepaper