Overview
Risk Adjustment is a process followed to determine the insurance eligibility of patients who have higher risks of developing specific conditions. As insurance payers need to provide the appropriate reimbursement rates for different providers, they need proper documentation as per the stringent guidelines.
While it’s possible to provide risk adjustment documentation in-house, the complexities and constraints involved can make it stressful and time-consuming for healthcare providers, and can shift their focus from the core task of providing care to their patients. Hiring professionals like ChampionsHealth ideally offers several benefits and multiple advantages.
Specialized Risk Adjustment
Champions Health has the requisite expertise to help healthcare providers with the required documentation, which is in accordance with all major risk model methodologies, including the HHS-HCC model, CMS-HCC model, and others. We also help the providers with the additional steps documentation required by the CMS payment model for members with acute or chronic illnesses.
Comprehensive Risk Adjustment Services
- Review of Prospective Risk
- Review of Concurrent Risk
- Review of Retrospective Risk
Review of Prospective Risk
Assessment of risk prior to the point of care requires intensive evaluation of documentation related to patient’s diagnostics and treatment reports. Our experts are adept at identifying the key insights, which can be used to deliver qualified conditions. Our specialized services like complete EMR integration, and NLP scrubbing help in supporting logic that physicians can utilize ahead of the date of service.
Review of Concurrent Risk
Concurrent review of risk is carried out in concurrence with the treatment process and requires risk adjusting ICD [HCC] codes in real-time. However, as only a few EHR systems are able to support the HCC model, we provide specialized concurrent risk services like HEDIS review and HCC capture to our clients, which is based on through evaluation of claims and auxiliary documentation.
Review of Retrospective Risk
The process involves a rigorous analysis of the risk stratification after the treatment. Through our expert capabilities like Precise RAPS submission, NLP scrubbing, and Dual abstraction, we are able to derive even the smallest details from the retrospective chart reviews to abstract the HCC codes to the highest-possible specification.
Benefits of partnering with us
- Our Risk Adjustment service enables optimal cost adjustments
- Through our detailed documentation, we are able to set the right standard of insurance premiums for high-risk enrollees.
- Our accurate documentation translates to appropriate funding and medication assistance
- Our professional services ensure improved care for high-risk patients
